High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort

Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population. High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 c...

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Published in:	European heart journal Vol. 35; no. 5; p. 271
Main Authors:	Zeller, Tanja, Tunstall-Pedoe, Hugh, Saarela, Olli, Ojeda, Francisco, Schnabel, Renate B, Tuovinen, Tarja, Woodward, Mark, Struthers, Allan, Hughes, Maria, Kee, Frank, Salomaa, Veikko, Kuulasmaa, Kari, Blankenberg, Stefan
Format:	Journal Article
Language:	English
Published:	England 01.02.2014
Subjects:	Biomarkers - blood Cardiovascular Diseases - blood Cardiovascular Diseases - mortality Cohort Studies Female Humans Immunoassay - methods Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - mortality Prevalence Risk Assessment Scotland - epidemiology Sex Distribution Stroke - blood Stroke - mortality Troponin I - blood Scotland High-sensitivity assayed troponin I MONICA Risk Genetics Archiving and Monograph (MORGAM) Mortality Cardiovascular risk Scottish Heart Health Extended Cohort (SHHEC)
ISSN:	1522-9645, 1522-9645
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Abstract	Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population. High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events. Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.
AbstractList	Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population. High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events. Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals. Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population.AIMSOur aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population.High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events.METHODS AND RESULTSHigh-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events.Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.CONCLUSIONTroponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.
Author	Schnabel, Renate B Kee, Frank Woodward, Mark Hughes, Maria Tunstall-Pedoe, Hugh Ojeda, Francisco Zeller, Tanja Saarela, Olli Blankenberg, Stefan Tuovinen, Tarja Kuulasmaa, Kari Salomaa, Veikko Struthers, Allan
Author_xml	– sequence: 1 givenname: Tanja surname: Zeller fullname: Zeller, Tanja organization: Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany – sequence: 2 givenname: Hugh surname: Tunstall-Pedoe fullname: Tunstall-Pedoe, Hugh – sequence: 3 givenname: Olli surname: Saarela fullname: Saarela, Olli – sequence: 4 givenname: Francisco surname: Ojeda fullname: Ojeda, Francisco – sequence: 5 givenname: Renate B surname: Schnabel fullname: Schnabel, Renate B – sequence: 6 givenname: Tarja surname: Tuovinen fullname: Tuovinen, Tarja – sequence: 7 givenname: Mark surname: Woodward fullname: Woodward, Mark – sequence: 8 givenname: Allan surname: Struthers fullname: Struthers, Allan – sequence: 9 givenname: Maria surname: Hughes fullname: Hughes, Maria – sequence: 10 givenname: Frank surname: Kee fullname: Kee, Frank – sequence: 11 givenname: Veikko surname: Salomaa fullname: Salomaa, Veikko – sequence: 12 givenname: Kari surname: Kuulasmaa fullname: Kuulasmaa, Kari – sequence: 13 givenname: Stefan surname: Blankenberg fullname: Blankenberg, Stefan
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SubjectTerms	Biomarkers - blood Cardiovascular Diseases - blood Cardiovascular Diseases - mortality Cohort Studies Female Humans Immunoassay - methods Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - mortality Prevalence Risk Assessment Scotland - epidemiology Sex Distribution Stroke - blood Stroke - mortality Troponin I - blood
Title	High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort
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