Plasma Transthyretin And Risk Of Incident Heart Failure

Background and Aims: Rare mutations in the transthyretin gene destabilize transthyretin tetramers in plasma, lower plasma transthyretin levels, and cause hereditary transthyretin cardiac amyloidosis which may manifest as heart failure. With increasing age, wildtype transthyretin tetramers also become unstable, and plasma levels of transthyretin decrease. Destabilized wildtype transthyretin may cause wildtype cardiac amyloidosis, a likely underdiagnosed aging phenomenon often manifesting as heart failure. However, it is unknown if low plasma levels of transthyretin per se mark an increased risk of incident heart failure in the general population. We aimed to test this hypothesis.