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, BiomarCaRE Investigators

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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
Issue number30
Early online date12 May 2016
Publication statusPublished - 07 Aug 2016

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    Blankenberg, S., Salomaa, V., Makarova, N., Ojeda, F., Wild, P., Lackner, K. J., 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, C. C., ... BiomarCaRE Investigators (2016). Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium. European Heart Journal, 37(30), 2428-2437.