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

被引：202

作者：

Blankenberg, Stefan ^{[1
,2
]}

Salomaa, Veikko ^{[3
]}

Makarova, Nataliya ^{[1
,2
]}

Ojeda, Francisco ^{[1
]}

Wild, Philipp ^{[4
,5
,6
]}

Lackner, Karl J. ^{[7
]}

Jorgensen, Torben ^{[8
,9
]}

Thorand, Barbara ^{[10
]}

Peters, Annette ^{[10
,11
]}

Nauck, Matthias ^{[12
,13
]}

Petersmann, Astrid ^{[12
,13
]}

Vartiainen, Erkki ^{[14
]}

Veronesi, Giovanni ^{[15
]}

Brambilla, Paolo ^{[16
]}

Costanzo, Simona ^{[17
]}

Iacoviello, Licia ^{[17
]}

Linden, Gerard ^{[18
]}

Yarnell, John ^{[19
]}

Patterson, Christopher C. ^{[19
]}

Everett, Brendan M. ^{[20
,21
]}

Ridker, Paul M. ^{[20
,21
]}

Kontto, Jukka ^{[3
]}

Schnabel, Renate B. ^{[1
,2
]}

Koenig, Wolfgang ^{[11
,22
,23
]}

Kee, Frank ^{[18
]}

Zeller, Tanja ^{[1
,2
]}

Kuulasmaa, Kari ^{[3
]}

机构：

[1] Univ Heart Ctr Hamburg, Clin Gen & Intervent Cardiol, Hamburg, Germany

[2] German Ctr Cardiovasc Res DZHK eV, Partner Site Hamburg, Hamburg, Germany

[3] Natl Inst Hlth & Welf, Helsinki, Finland

[4] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med Prevent Cardiol & Prevent Med 2, Mainz, Germany

[5] Johannes Gutenberg Univ Mainz, Univ Med Ctr, CTH, Mainz, Germany

[6] German Ctr Cardiovasc Res DZHK, Partner Site Rhein Main, Mainz, Germany

[7] Univ Med Ctr Mainz, Inst Clin Chem & Lab Med, Mainz, Germany

[8] Univ Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, Copenhagen, Denmark

[9] Res Ctr Prevent & Hlth, Capital Region, Denmark

[10] Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 2, Munich, Germany

[11] German Ctr Cardiovasc Res DZHK eV, Partner Site Munich Heart Alliance, Munich, Germany

[12] Univ Med Greifswald, Inst Clin Chem & Lab Med, Greifswald, Germany

[13] German Ctr Cardiovasc Res DZHK eV, Partner Site Greifswald, Greifswald, Germany

[14] Natl Inst Hlth & Welf, Dept Chron Dis Prevent, Chron Dis Epidemiol & Prevent Unit, Helsinki, Finland

[15] Univ Insubria, Res Ctr Epidemiol & Prevent Med, Dept Clin & Expt Med, Varese, Italy

[16] Univ Milano Bicocca, Hosp Desio, Dept Lab Med, Desio, MB, Italy

[17] IRCCS Ist Neurol Mediterraneo Neuromed, Dept Epidemiol & Prevent, Lab Mol & Nutr Epidemiol, Pozzilli, Isernia, Italy

[18] Queens Univ Belfast, UK Clin Res Collaborat Ctr Excellence Publ Hlth, Belfast, Antrim, North Ireland

[19] Queens Univ Belfast, Ctr Publ Hlth Belfast, Belfast, Antrim, North Ireland

[20] Brigham & Womens Hosp, Div Cardiovasc, 75 Francis St, Boston, MA 02115 USA

[21] Brigham & Womens Hosp, Div Prevent Med, 75 Francis St, Boston, MA 02115 USA

[22] Univ Ulm, Med Ctr, Dept Internal Med Cardiol 2, Ulm, Germany

[23] Tech Univ Munich, German Heart Ctr Munich, Munich, Germany

来源：

EUROPEAN HEART JOURNAL | 2016年 / 37卷 / 30期

基金：

英国医学研究理事会;

关键词：

High-sensitivity assayed troponin I; Cardiovascular risk; Mortality; Biomarker for Cardiovascular Risk Assessment in Europe; MONICA Risk Genetics Archiving and Monograph; HIGHLY SENSITIVE ASSAY; CORONARY-HEART-DISEASE; ASSOCIATION TASK-FORCE; 2013 ACC/AHA GUIDELINE; NATRIURETIC PEPTIDE; AMERICAN-COLLEGE; PROGNOSTIC VALUE; VASCULAR EVENTS; CARDIAC EVENTS; ALL-CAUSE;

D O I：

10.1093/eurheartj/ehw172

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：2428 / +

页数：11

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