Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study

Maria F Hughes, Francisco Ojeda, Olli Saarela, Torben Jørgensen, Tanja Zeller, Tarja Palosaari, Mark G O'Doherty, Anders Borglykke, Kari Kuulasmaa, Stefan Blankenberg, Frank Kee

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Abstract

BACKGROUND: High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined.

METHODS: We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics.

RESULTS: Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744).

CONCLUSIONS: The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.

LanguageEnglish
Pages334-342
Number of pages9
JournalClinical Chemistry
Volume63
Issue number1
Early online date01 Dec 2016
DOIs
Publication statusPublished - 01 Jan 2017

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Troponin I
Cardiovascular Diseases
Population
Joints
Primary Prevention
Proportional Hazards Models
Hazards
Prospective Studies
Statistics

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Hughes, Maria F ; Ojeda, Francisco ; Saarela, Olli ; Jørgensen, Torben ; Zeller, Tanja ; Palosaari, Tarja ; O'Doherty, Mark G ; Borglykke, Anders ; Kuulasmaa, Kari ; Blankenberg, Stefan ; Kee, Frank. / Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study. In: Clinical Chemistry. 2017 ; Vol. 63, No. 1. pp. 334-342.
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abstract = "BACKGROUND: High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined.METHODS: We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51{\%} female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics.RESULTS: Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95{\%} CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744).CONCLUSIONS: The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.",
author = "Hughes, {Maria F} and Francisco Ojeda and Olli Saarela and Torben J{\o}rgensen and Tanja Zeller and Tarja Palosaari and O'Doherty, {Mark G} and Anders Borglykke and Kari Kuulasmaa and Stefan Blankenberg and Frank Kee",
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Hughes, MF, Ojeda, F, Saarela, O, Jørgensen, T, Zeller, T, Palosaari, T, O'Doherty, MG, Borglykke, A, Kuulasmaa, K, Blankenberg, S & Kee, F 2017, 'Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study', Clinical Chemistry, vol. 63, no. 1, pp. 334-342. https://doi.org/10.1373/clinchem.2016.261172

Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study. / Hughes, Maria F; Ojeda, Francisco; Saarela, Olli; Jørgensen, Torben; Zeller, Tanja; Palosaari, Tarja; O'Doherty, Mark G; Borglykke, Anders; Kuulasmaa, Kari; Blankenberg, Stefan; Kee, Frank.

In: Clinical Chemistry, Vol. 63, No. 1, 01.01.2017, p. 334-342.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study

AU - Hughes, Maria F

AU - Ojeda, Francisco

AU - Saarela, Olli

AU - Jørgensen, Torben

AU - Zeller, Tanja

AU - Palosaari, Tarja

AU - O'Doherty, Mark G

AU - Borglykke, Anders

AU - Kuulasmaa, Kari

AU - Blankenberg, Stefan

AU - Kee, Frank

N1 - © 2016 American Association for Clinical Chemistry.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - BACKGROUND: High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined.METHODS: We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics.RESULTS: Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744).CONCLUSIONS: The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.

AB - BACKGROUND: High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined.METHODS: We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics.RESULTS: Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744).CONCLUSIONS: The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.

U2 - 10.1373/clinchem.2016.261172

DO - 10.1373/clinchem.2016.261172

M3 - Article

VL - 63

SP - 334

EP - 342

JO - Clinical Chemistry

T2 - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

IS - 1

ER -