High-Sensitivity Troponins and Subclinical Coronary Atherosclerosis Evaluated by Coronary Calcium Score Among Older Asians Living With Well-Controlled Human Immunodeficiency Virus
Authors: Chattranukulchai Pairoj , Vassara Manasawee , Siwamogsatham Sarawut , Buddhari Wacin , Tumkosit Monravee , Ketloy Chutitorn , Shantavasinkul Prapimporn , Apornpong Tanakorn , Lwin Hay Mar Su , Kerr Stephen J , Boonyaratavej Smonporn , Avihingsanon Anchalee ,   HIV-NAT 006/207 study team, Phanuphak Praphan , Ruxrungtham Kiat , Avihingsanon Anchalee , Gatechompol Sivaporn , Lwin Hay Mar Su , Han Win Min , Woratanarat Kobchoke , Hiransuthikul Akarin , Wichiansan Thanathip , Boonrungsirisap Jedsadakorn , Kerr Stephen J , Apornpong Tanakorn , Sophonphan Jiratchaya , Phonphithak Supalak , Wongvoranet Chuleeporn , Chaiyahong Prachya , Jirapasiri Jaravee , Sarachat Paritaporn , Setta Nattawadee , Supakawee Khuanruan , Duchchanutat Supaporn , Ruengpanyathip Chavalun , Phadungphon Chowalit , Treepattanasuwan Orathai , Boonmangum Theeradej , Lertarrom Plengsri , Uanithirat Anuntaya , Chanthaburanun Sararut , Anuchadbut Anongnart , Tanjedrew Piyaporn , Longcharaen Ratree , Wongthai Niti , Sattong Threepol , Ubolyam Sasiwimol , Mahanontharit Apicha , Sopa Bunruan , Chobkarching Umaporn , Bouko Channuwat , Phongam Nuchtida , Iampornsin Thatri , Dalodom Theera , Khlaiphuengsin Apichaya , Plakunmonthon Sasitorn , Nanthapisal Kesdao , Methanggool Umaporn , Thangjitthanom Chornarin , Sirichumpa Kanokon , Chobkarjing Jutharos , Jamrasrak Adisak , Pitayanon Natthapa , Phuengchangam Engon , Chattranukulchai Pairoj , Vassara Manasawee , Buddhari Wacin , Songmuang Smonporn Boonyaratavej , Thimaporn Weerayut , Siwamogsatham Sarawut , Tumkosit Monravee , Ketloy Chutitorn , Shantavasinkul Prapimporn , Sunthomyothin Sarat , Wattanachanya Lalita , Chaiwatanarat Tawachai , Chutinet Aurauma , Vongsayan Pongpat , Samajarn Jitrada , Putcharoen Opass , Satitthummanid Sudarat , Ariyachaipanich Aekarach 
Published: May 2023

Abstract

Background
Elevated levels of high-sensitivity cardiac troponin (hs-cTn) are suggestive of myocardial cell injury and coronary artery disease. We explored the association between hs-cTn and subclinical arteriosclerosis using coronary artery calcification (CAC) scoring among 337 virally suppressed patients with human immunodeficiency virus (HIV) who were ≥50 years old and without evidence of known coronary artery disease.

Methods
Noncontrast cardiac computed tomography and blood sampling for hs-cTn, both subunit I (hs-cTnI) and subunit T (hs-cTnT), were performed. The relationship between CAC (Agatston score) and serum hs-cTn levels was analyzed using Spearman correlation and logistic regression models.

Results
The patients, of whom 62% were male, had a median age of 54 years and had been on antiretroviral therapy for a median of 16 years; the CAC score was &gt;0 in 50% of patients and ≥100 in 16%. Both hs-cTn concentrations were positively correlated with the Agatston score, with correlation coefficients of 0.28 and 0.27 (P &lt; .001) for hs-cTnI and hs-cTnT, respectively. hs-cTnI and hs-cTnT concentrations of ≥4 and ≥5.3 pg/mL, respectively, provided the best performance for discriminating patients with Agatston scores ≥100, with a sensitivity and specificity of 76% and 60%, respectively, for hs-cTnI and 70% and 50% for hs-cTnT. In multivariable logistic regression analysis, each log unit increase in hs-cTnI level was independently associated with increased odds of having an Agatston score ≥100 (odds ratio, 2.83 [95% confidence interval, 1.69–4.75]; P &lt;.001). Although not an independent predictor, hs-cTnT was also associated with an increased odds of having an Agatston score ≥100 (odds ratio, 1.58 [95% confidence interval, .92–2.73]; P = .10).

Conclusions
Among Asians aged ≥50 years with well-controlled HIV infection and without established cardiovascular disease, 50% had subclinical arteriosclerosis. Increasing hs-cTnI and hs-cTnT concentrations were associated with an increased risk of severe subclinical arteriosclerosis, and hs-cTn may be a potential biomarker to detect severe subclinical arteriosclerosis.