A high-sensitivity blood test – which costs only £5 – could predict heart attack risk in people, according to a study funded by the British Heart Foundation (BHF).
The troponin test – currently used to diagnose a heart attack – could also be more effectively used to assess future heart disease risk than cholesterol or blood pressure.
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As a result, the test could more precisely identify people who will benefit from statins, and assess statins’ impact in lowering someone's heart disease risk, say researchers.
“These results are tremendously exciting, and could revolutionize the way we manage patients at risk of coronary heart disease,” said Professor Nicholas Mills, BHF Senior Clinical Research Fellow at the University of Edinburgh.
A troponintest measures the levels troponin T or troponin I proteins in the blood. These proteins are released into the bloodstream when the heart muscle is damaged due to a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood.
Patients suspected of suffering a heart attack are often given a troponin test to help diagnosis, but until now the test has not been used to predict future heart attack risk.
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Coronary heart disease also known as ischemic heart disease, is the cause of heart attacks. Coronary heart disease is the single biggest killer in the UK, accounting for nearly 70,000 deaths in the country each year.
For the study, a team of researchers from the University of Edinburgh and University of Glasgow recruited over 3,000 men with high cholesterol but no history of heart disease.
The team found that a high-sensitivity troponin test from Abbott Diagnostics precisely predicted the risk of a person suffering a heart attack or dying of coronary heart disease up to 15 years later.
Troponin enhanced the prediction of coronary heart disease risk compared to traditional markers, such as cholesterol levels and blood pressure.
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If borne out in larger, and more diverse studies, physicians may be able to use the troponin test to determine which patients are most likely to develop coronary heart disease.
The researchers also found that by measuring troponin levels in the blood they could tell which patients were responding to the statins used to treat them.
Statin intake reduced troponin levels. Those whose troponin levels reduced the most had a 5-fold lower risk of heart attack or death from coronary heart disease compared with those whose troponin levels increased or remained the same. While reduced troponin level could indicate treatment is effective, any increases in blood troponin could prompt a change in treatment strategy.
Doctors use statins to prevent coronary heart disease in people who are considered high-risk, but like any other medical condition, more precise risk assessment could aid doctors to target treatment to those who need it most.
Higher levels of troponin may indicate 'silent' coronaryartery disease, and pinpoint those at greatest risk and help them benefit from targeted therapy.
While the study seems encouraging, these results were obtained in a population of middle-aged men with high blood cholesterol. Before the test is used in clinical practice, further study will be needed to determine whether the same effects are found in women and men with lower cholesterol levels.
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"Whilst blood cholesterol levels and blood pressure are important and associated with the risk of developing heart disease, troponin is a direct measure of injury to the heart. Troponin testing will help doctors to identify apparently healthy individuals who have silent heart disease so we can target preventative treatments to those who are likely to benefit most," says Prof. Mills.
Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, says:
"Thanks in part to research funded by the BHF the use of troponin tests to determine whether or not a person has had a heart attack when they first arrive at hospital is now firmly established in clinical practice.”
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Prof. Samani hopes because of this study, they may be able to use this simple test earlier on to identify people at higher risk of suffering from a heart attack, and intensify preventative treatment for those found to be at higher risk.
"Before the findings from this research can be clinically applied, the usefulness of measuring troponin findings need to be demonstrated in a wider group of patients. If this confirms its value, the test could easily be administered by GPs during standard check-ups, and could ultimately save lives," concludes Prof. Samani.
The study, published in the Journal of the American College of Cardiology.
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