Troponin i and cardiovascular risk prediction in the general population: The BiomarCaRE consortium

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)2428-2437
Number of pages10
JournalEuropean Heart Journal
Volume37
Issue number30
DOIs
Publication statusPublished - Aug 7 2016

Fingerprint

Troponin
Troponin I
Biomarkers
Cardiovascular Diseases
Population
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
Cardiovascular Models
Numbers Needed To Treat
Risk Reduction Behavior
Therapeutics

Keywords

  • Biomarker for Cardiovascular Risk Assessment in Europe
  • Cardiovascular risk
  • High-sensitivity assayed troponin I
  • MONICA Risk Genetics Archiving and Monograph
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Blankenberg, S., Salomaa, V., Makarova, N., Ojeda, F., Wild, P., Lackner, K. J., ... Kuulasmaa, K. (2016). Troponin i and cardiovascular risk prediction in the general population: The BiomarCaRE consortium. European Heart Journal, 37(30), 2428-2437. https://doi.org/10.1093/eurheartj/ehw172

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.

In: European Heart Journal, Vol. 37, No. 30, 07.08.2016, p. 2428-2437.

Research output: Contribution to journalArticle

Blankenberg, S, Salomaa, V, Makarova, N, Ojeda, F, Wild, P, Lackner, KJ, Jørgensen, T, Thorand, B, Peters, A, Nauck, M, Petersmann, A, Vartiainen, E, Veronesi, G, Brambilla, P, Costanzo, S, Iacoviello, L, Linden, G, Yarnell, J, Patterson, CC, Everett, BM, Ridker, PM, Kontto, J, Schnabel, RB, Koenig, W, Kee, F, Zeller, T & Kuulasmaa, K 2016, 'Troponin i and cardiovascular risk prediction in the general population: The BiomarCaRE consortium', European Heart Journal, vol. 37, no. 30, pp. 2428-2437. https://doi.org/10.1093/eurheartj/ehw172
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. / Troponin i and cardiovascular risk prediction in the general population : The BiomarCaRE consortium. In: European Heart Journal. 2016 ; Vol. 37, No. 30. pp. 2428-2437.
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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

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AU - Zeller, Tanja

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