Even Very Low Levels of Cardiac Troponin T Linked to Heart Failure, Cardiovascular Death Even very low levels of cardiac troponin T are associated with increased risk for heart failure and cardiovascular death among patients with stable heart disease, according to an industry-funded study in the New England Journal of Medicine.
Using a highly sensitive assay, researchers tested for troponin T in nearly 3700 adults with stable coronary artery disease and preserved left ventricular function, and then followed them for roughly 5 years. (The assay is not commercially available.)
The test detected very low troponin T levels in nearly all subjects — levels that would have gone undetected using conventional assays, the researchers write. Even at these low concentrations, increasing troponin T was associated with elevated risk for cardiovascular death or heart failure (but not MI).
Published in Physician’s First Watch November 30, 2009
Chronic Pain Linked to Greater Risk for Fall in the Elderly Chronic pain among older adults is a risk factor for falls, according to a study in JAMA.
Researchers assessed pain among roughly 750 community-dwelling adults (aged 70 and older) at baseline and at monthly intervals. Over 18 months, 55% of the participants fell at least once. In adjusted analyses, seniors who had more pain at baseline — i.e., greater number of joints with pain, more severe pain, or greater pain interference with daily activities were at increased risk for falling, compared with those reporting little or no pain. The researchers also found an association between monthly pain severity and risk for falls in the subsequent month.
The authors speculate that the following factors may contribute to the observed association: local joint pathology, neuromuscular effects leading to muscle weakness, and pain interfering with executive function or cognition.
Published in Physician’s First Watch November 25, 2009
Tool to Estimate Short-Term Risk for Ischemic Stroke Recurrence
A new tool to assess 90-day risk for ischemic stroke recurrence, the RRE-90 (http://www.nmr.mgh. harvard.edu/RRE/), might help clinicians identify patients most in need of prompt follow-up.
A retrospective analysis of the tool in some 1400 patients, published in Neurology, showed that a combination of clinical and, when available, MRI features had sufficient calibration and good discrimination in predicting early recurrent stroke. The independent predictors included history of TIA or stroke, image findings, and stroke etiology. The model held up well in a small validation cohort.