Clinically Important Improvements in Risk Assessment by Adding High-Sensitivity Troponin Level to Cholesterol Guidelines

A common mantra in modern cardiology is that any increase in troponin levels is bad, no matter what the cause. This previously applied to increases above the 99th percentile upper reference limit for contemporary assays. Now there are multiple studies showing increasing risk with increasing high-sensitivity (hs) troponin levels within the normal range.¹ Another such study is reported in this issue of JAMA Cardiology by Marston and coworkers,² who enrolled 8635 patients in the Long-term Use of Ticagrelor in Patients With Prior Myocardial Infarction (PEGASUS-TIMI 54) trial who had a myocardial infarction (MI) 1 to 3 years earlier. High-sensitivity troponin I levels within the normal range enhanced cardiovascular risk stratification based on 13 clinical criteria from the 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol management guidelines.³