Factors independently associated with cardiac troponin I levels in young and healthy adults from the general population

Clin Res Cardiol. 2017 Feb;106(2):96-104. doi: 10.1007/s00392-016-1026-5. Epub 2016 Aug 17.


Background: Determinants of cardiomyocyte injury as quantified by high-sensitivity cardiac troponin I (cTnI) in young and healthy individuals, and sex-specific 99th percentiles are largely unknown.

Methods: Our study included 2077 adults from the general population aged 25-41 years without cardiovascular disease. cTnI was measured using a high-sensitivity assay. We performed stepwise backward linear regression analyses to identify variables independently associated with hs-cTnI levels, and calculated narrow-sense heritability from 1638-genotyped participants.

Results: Median age was 37 years. cTnI was quantifiable in all but 11 participants (99.5 %). Median (interquartile range) cTnI was significantly higher in men than in women [0.99 (0.71; 1.65) versus 0.47 (0.33; 0.71) ng/L, p < 0.0001]. The 99th percentile of cTnI was 15.79 ng/L in men and 5.11 ng/L in women. Out of 46 variables, 22 independent determinants for cTnI were identified. The strongest associations were observed with sex, age, systolic blood pressure, heart rate, left ventricular mass, N-terminal pro B-type natriuretic peptide, and creatine kinase (all p < 0.0001). The final model explained 36 % of the overall cTnI variability. Heritability of cTnI was estimated to be 29 % (p = 0.005), but became non-significant when the residuals of the multivariable model were used for analysis (5 %, p = 0.36).

Conclusions: Sex, age, and systolic blood pressure belong to the strongest determinants of hs-cTnI in healthy adults. The 99th percentile was three times higher in men compared to women. Hence, sex-specific cut-off values may be preferable when applying hs-cTnI for screening purposes. Our results may also improve the interpretation of cTn levels in daily clinical practice.

Keywords: Age; B-type natriuretic peptide; Blood pressure; Epidemiology; Heritability; Hypertrophy; Sex; Troponin.

MeSH terms

  • Adult
  • Age Factors
  • Biomarkers / blood
  • Blood Pressure
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / genetics
  • Cardiovascular Diseases / physiopathology
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Female
  • Genotype
  • Healthy Volunteers
  • Heredity
  • Humans
  • Linear Models
  • Male
  • Multivariate Analysis
  • Nonlinear Dynamics
  • Phenotype
  • Predictive Value of Tests
  • Risk Factors
  • Sex Factors
  • Troponin I / blood*


  • Biomarkers
  • Troponin I