Author + information
- Elizabeth Selvin, PhD, MPH⁎ ( and )
- Jonathan Rubin, MD, MHS
- ↵⁎Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, Maryland 21287
We thank Dr. Raposeiras-Roubín and colleagues for their interest in our paper (1). They postulate that advanced glycation endproducts (AGEs) may mediate the association between hyperglycemia and myocardial damage. We mentioned AGEs as a possible mechanism that may explain the observed association between glycated hemoglobin (HbA1c) and high-sensitivity cardiac troponin T (hs-cTnT) in our study. We agree that this is an interesting question that deserves further study. Unfortunately, it is difficult to obtain tissue AGE measurements in population-based studies and, unlike HbA1c, blood AGE measurements are not used clinically.
Dr. Farmakis and colleagues express concern that we excluded participants with a history of coronary heart disease, stroke, chronic kidney disease, or atrial fibrillation in our study of a community-based population. These exclusions are important because hs-cTnT will be elevated in the setting of structural heart disease and circulating levels may be affected by kidney function. Stronger associations between HbA1c and hs-cTnT were observed in the overall study population when no exclusions were applied. Dr. Farmakis and colleagues also discuss uncertainty surrounding the interpretation of slightly elevated troponin levels in the general population. We agree with both Dr. Farmakis and colleagues and Dr. Korosoglou and colleagues that additional studies are needed to understand the potential clinical relevance of new hs-cTnT assays.
- American College of Cardiology Foundation