Performance of High-Sensitivity Cardiac Troponin Assays to Reflect Comorbidity Burden and Improve Mortality Risk Stratification in Older Adults With Diabetes

Diabetes Care. 2020 Jun;43(6):1200-1208. doi: 10.2337/dc19-2043. Epub 2020 Mar 11.


Objective: Incorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification.

Research design and methods: We used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67-89 years, 43% male, 31% black) at visit 5 (2011-2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels.

Results: Elevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (hazard ratio 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality.

Conclusions: Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atherosclerosis / blood
  • Atherosclerosis / diagnosis
  • Atherosclerosis / etiology
  • Atherosclerosis / mortality
  • Biomarkers / analysis
  • Biomarkers / blood
  • Comorbidity
  • Cost of Illness
  • Diabetes Complications / blood
  • Diabetes Complications / diagnosis*
  • Diabetes Complications / epidemiology
  • Diabetes Complications / mortality*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / mortality*
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / methods
  • Humans
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Troponin T / analysis
  • Troponin T / blood*


  • Biomarkers
  • Troponin T