Prognostic Value of Cardiac Myosin Binding Protein C in the General Population: The Akershus Cardiac Examination 1950 Study

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BACKGROUND: Cardiac myosin binding protein C (cMyC) is a cardiac-specific biomarker that is released after acute ischemic myocardial injury. Cardiac troponins are established cardiac biomarkers of myocardial injury and provide prognostic information in patients with cardiovascular disease (CVD) and in healthy persons from the general population. There is limited data documenting the prognostic value of cMyC in a general population setting. Accordingly, we assessed the prognostic value of cMyC for incident major adverse cardiovascular events (MACE) and mortality in a general population cohort and contrasted these associations with those of cardiac troponins. METHODS: We measured cMyC, high-sensitivity cardiac troponin I (hs-cTnI), and high-sensitivity T (hs-cTnT) in serum samples from 3682 community dwellers born in 1950 at the baseline of the Akershus Cardiac Examination 1950 Study obtained from 2012 to 2015. We assessed the associations of all three biomarkers with a composite MACE outcome (nonfatal myocardial infarction, nonfatal ischemic stroke, nonfatal heart failure, myocardial revascularization, or cardiovascular mortality), as well as with all-cause, cardiovascular and non-cardiovascular mortality separately. RESULTS: The median age was 63.9 years and 1885 were male. After a median follow-up of 8.3 years, we recorded 307 composite MACE outcomes and 191 deaths. cMyC was associated with risk of MACE, as was hs-cTnI and hs-cTnT (all P for log-rank test <0.001). cMyC remained independently associated with MACE (hazard ratio per 1 SD in log-transformed biomarker 1.25, 95% CI, 1.14-1.37) and cardiovascular death (hazard ratio 1.41, 95% CI 1.15-1.72) in adjusted analyses and after further adjustment for hs-cTnI or hs-cTnT. CONCLUSIONS: cMyC provides strong prognostic information for incident CVD in the general population, independently of that provided by cardiac troponins.

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