TY - JOUR
T1 - Troponin I and cardiovascular risk prediction in the general population
T2 - the BiomarCaRE consortium
AU - Blankenberg, Stefan
AU - Salomaa, Veikko
AU - Makarova, Nataliya
AU - Ojeda, Francisco
AU - Wild, Philipp
AU - Lackner, Karl J
AU - Jørgensen, Torben
AU - Thorand, Barbara
AU - Peters, Annette
AU - Nauck, Matthias
AU - Petersmann, Astrid
AU - Vartiainen, Erkki
AU - Veronesi, Giovanni
AU - Brambilla, Paolo
AU - Costanzo, Simona
AU - Iacoviello, Licia
AU - Linden, Gerard
AU - Yarnell, John
AU - Patterson, Christopher C
AU - Everett, Brendan M
AU - Ridker, Paul M
AU - Kontto, Jukka
AU - Schnabel, Renate B
AU - Koenig, Wolfgang
AU - Kee, Frank
AU - Zeller, Tanja
AU - Kuulasmaa, Kari
AU - BiomarCaRE Investigators
N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2016/8/7
Y1 - 2016/8/7
N2 - AIMS: Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively.METHODS AND RESULTS: Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar.CONCLUSION: In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of cardiovascular death and cardiovascular disease.
AB - AIMS: Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively.METHODS AND RESULTS: Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar.CONCLUSION: In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of cardiovascular death and cardiovascular disease.
KW - Journal Article
U2 - 10.1093/eurheartj/ehw172
DO - 10.1093/eurheartj/ehw172
M3 - Journal article
C2 - 27174290
SN - 1522-9645
VL - 37
SP - 2428
EP - 2437
JO - European Heart Journal (Online)
JF - European Heart Journal (Online)
IS - 30
ER -