Cardiac troponins, when measured using highly sensitive assays, appear to be among the most powerful prognostic biomarkers yet identified for risk assessment in the general population. Very low troponin levels detectable with these highly sensitive assays are correlated with multiple clinical determinants of future heart failure risk and cardiovascular death. Corresponding imaging evidence of subclinical heart disease includes strong associations between cardiac troponins, left ventricular hypertrophy, and reduced left ventricular ejection fraction. This is in contrast to the poor correlation with coronary disease. Cardiac troponins provide complementary information to natriuretic peptides, as well as measures of renal function, and appear to outperform high-sensitivity C-reactive protein in predicting risk for a variety of cardiovascular disease endpoints. Additional research is now needed to define the role of highly sensitive troponin assays in screening of the general population and risk assessment.