Author + information
- Giuseppe Lippi, MD∗ ( )( and )
- Gianfranco Cervellin, MD
- ↵∗U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
We read with interest the paper by White et al. (1), who reported that both baseline troponin I levels and change at 1 year measured with a latest-generation immunoassay are reliable predictors of coronary heart disease, death, and myocardial infarction after adjustment for the most important cardiovascular risk factors, including sex, age, body mass index, diabetes, smoking, hypertension, total and high-density lipoprotein cholesterol, triglycerides, and fasting glucose.
Since their original publication in 2002 (2) and the update in 2004 (3), the Adult Treatment Panel (ATP) III Guidelines have represented a cornerstone for the management of high blood cholesterol and related disorders. Although enthusiastically awaited, the next update of this document (i.e., the ATP IV) has not been published so far. The evidence for a substantial revision of available recommendations is weak, however, because no major progress has been made in the management of dyslipidemia in the past decade. Nevertheless, the data published by White et al. (1), which confirm previous findings from separate investigations (4), support the notion that chronic troponin elevations truly mirror a pathophysiological process that is distinct from the acute increase more typically observed in patients with myocardial infarction. Recent advances in our understanding of the pathogenesis of ischemic heart disease confirm that the turnover of cardiospecific troponins is substantially increased in patients with coronary artery disease, and their plasma levels significantly correlate with the burden of coronary atherosclerosis (5). As such, it seems now unquestionable that the assessment of these cardiospecific biomarkers would provide a net incremental benefit for cardiovascular risk assessment, not only in patients with established coronary artery disease, but also in the general population (4). While “waiting for Godot” (i.e., the ATP IV), it seems reasonable to suggest that the expert panel of the National Cholesterol Education Program should not ignore the valuable information that cardiospecific troponins may provide for the screening and prevention of cardiovascular risk, especially when these biomarkers are measured with the latest generation of highly-sensitive immunoassays.
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