Background: Cardiac troponin concentrations differ in women and men, but how this influences risk prediction and whether a sex-specific approach is required is unclear. We evaluated whether sex influences the predictive ability of cardiac troponin I and T for cardiovascular events in the general population.
Methods: High-sensitivity cardiac troponin (hs-cTn) I and T were measured in the Generation Scotland Scottish Family Health Study of randomly selected volunteers drawn from the general population between 2006 and 2011. Cox-regression models evaluated associations between hs-cTnI and hs-cTnT and the primary outcome of cardiovascular death, myocardial infarction or stroke.
Results: In 19,501 (58% women, age 47 years) participants the primary outcome occurred in 2.7% (306/11,375) of women and 5.1% (411/8,126) of men during the median follow-up period of 7.9 [IQR,7.1-9.2] years. Cardiac troponin I and T levels were lower in women than men (P<0.001 for both), and both were more strongly associated with cardiovascular events in women than men. For example, at a hs-cTnI level of 10 ng/L, the hazard ratio relative to the limit of blank was 9.7 (95% confidence interval [CI] 7.6-12.4) and 5.6 (95% CI 4.7-6.6) for women and men, respectively. The hazard ratio for hs-cTnT at a level of 10 ng/L relative to the limit of blank was 3.7 (95% CI 3.1–4.3) and 2.2 (95% CI 2.0-2.5) for women and men, respectively.
Conclusions: Cardiac troponin concentrations differ in women and men and are stronger predictors of cardiovascular events in women. Sex-specific approaches are required to provide equivalent risk prediction.