Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.

Blankenberg, Stefan; Salomaa, Veikko; Makarova, Nataliya; Ojeda, Francisco; Wild, Philipp; Lackner, Karl J; Jørgensen, Torben; Thorand, Barbara; Peters, Annette; Nauck, Matthias; Petersmann, Astrid; Vartiainen, Erkki; Veronesi, Giovanni; Brambilla, Paolo; Costanzo, Simona; Iacoviello, Licia; Linden, Gerard; Yarnell, John; Patterson, Christopher C; Everett, Brendan M; Ridker, Paul M; Kontto, Jukka; Schnabel, Renate B; Koenig, Wolfgang; Kee, Frank; Zeller, Tanja; Kuulasmaa, Kari

doi:10.1093/eurheartj/ehw172

journal article

Titel:: Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.
Dokumenttyp:: Journal Article
Autor(en):: Blankenberg, Stefan; Salomaa, Veikko; Makarova, Nataliya; Ojeda, Francisco; Wild, Philipp; Lackner, Karl J; Jørgensen, Torben; Thorand, Barbara; Peters, Annette; Nauck, Matthias; Petersmann, Astrid; Vartiainen, Erkki; Veronesi, Giovanni; Brambilla, Paolo; Costanzo, Simona; Iacoviello, Licia; Linden, Gerard; Yarnell, John; Patterson, Christopher C; Everett, Brendan M; Ridker, Paul M; Kontto, Jukka; Schnabel, Renate B; Koenig, Wolfgang; Kee, Frank; Zeller, Tanja; Kuulasmaa, Kari
Abstract:: 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.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.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.
Zeitschriftentitel:: Eur Heart J
Jahr:: 2016
Band / Volume:: 37
Heft / Issue:: 30
Seitenangaben Beitrag:: 2428-37
Sprache:: eng
Volltext / DOI:: doi:10.1093/eurheartj/ehw172
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/27174290
Print-ISSN:: 0195-668X
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2016