TY - JOUR
T1 - Cardiac Troponin I and Incident Stroke in European Cohorts. Insights From the BiomarCaRE Project
AU - BiomarCaRE consortium
AU - Camen, Stephan
AU - Palosaari, Tarja
AU - Reinikainen, Jaakko
AU - Sprünker, Ngoc Anh
AU - Niiranen, Teemu
AU - Gianfagna, Francesco
AU - Vishram-Nielsen, Julie K K
AU - Costanzo, Simona
AU - Söderberg, Stefan
AU - Palmieri, Luigi
AU - Ferrario, Marco
AU - Peters, Annette
AU - Vartiainen, Erkki
AU - Donati, Maria Benedetta
AU - Donfrancesco, Chiara
AU - Borchini, Rossana
AU - Börschel, Christin Susanna
AU - Giampaoli, Simona
AU - Di Castelnuovo, Augusto
AU - Magnussen, Christina
AU - Kee, Frank
AU - Koenig, Wolfgang
AU - Blankenberg, Stefan
AU - de Gaetano, Giovanni
AU - Tunstall-Pedoe, Hugh
AU - Rospleszcz, Susanne
AU - Jørgensen, Torben
AU - Zeller, Tanja
AU - Kuulasmaa, Kari
AU - Linneberg, Allan
AU - Salomaa, Veikko
AU - Iacoviello, Licia
AU - Schnabel, Renate B
PY - 2020/9
Y1 - 2020/9
N2 - BACKGROUND AND PURPOSE: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce.METHODS: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries.RESULTS: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021).CONCLUSIONS: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.
AB - BACKGROUND AND PURPOSE: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce.METHODS: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries.RESULTS: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021).CONCLUSIONS: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.
KW - Biomarkers
KW - Cohort Studies
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardium/metabolism
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Registries
KW - Risk Factors
KW - Stroke/epidemiology
KW - Troponin I/metabolism
U2 - 10.1161/STROKEAHA.120.029452
DO - 10.1161/STROKEAHA.120.029452
M3 - Article
C2 - 32811388
VL - 51
SP - 2770
EP - 2777
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 9
ER -