Comparison of three troponins as predictors of future cardiovascular events--prospective results from the FINRISK and BiomaCaRE studies
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Comparison of three troponins as predictors of future cardiovascular events--prospective results from the FINRISK and BiomaCaRE studies. / Neumann, Johannes Tobias; Havulinna, Aki S; Zeller, Tanja; Appelbaum, Sebastian; Kunnas, Tarja; Nikkari, Seppo; Jousilahti, Pekka; Blankenberg, Stefan; Sydow, Karsten; Salomaa, Veikko.
In: PLOS ONE, Vol. 9, No. 3, 2014, p. e90063.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of three troponins as predictors of future cardiovascular events--prospective results from the FINRISK and BiomaCaRE studies
AU - Neumann, Johannes Tobias
AU - Havulinna, Aki S
AU - Zeller, Tanja
AU - Appelbaum, Sebastian
AU - Kunnas, Tarja
AU - Nikkari, Seppo
AU - Jousilahti, Pekka
AU - Blankenberg, Stefan
AU - Sydow, Karsten
AU - Salomaa, Veikko
PY - 2014
Y1 - 2014
N2 - IMPORTANCE AND OBJECTIVE: Besides their role in diagnosis of acute myocardial infarction (MI), troponins may be powerful biomarkers for risk stratification in the general population. The objective of our study was to compare the performance of three troponin assays in cardiovascular disease (CVD) risk prediction in a population-based cohort without a history of CVD events.DESIGN, SETTING AND PARTICIPANTS: Troponin I concentrations were measured using a contemporary-sensitivity, high-sensitivity, and super-sensitivity assay in 7,899 participants of the general-population based FINRISK 1997 cohort. 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 over-optimism.MAIN OUTCOME: As outcome measures we used CVD, MI, ischemic stroke, heart failure (HF), and major adverse cardiac events (MACE). During the follow-up of 14 years 1,074 incident MACE were observed.RESULTS: Values above the lower limit of detection were observed in 26.4%, 81.5% and 93.9% for the contemporary-sensitivity, high-sensitivity and super-sensitivity assay, respectively. We observed significant associations of troponin concentrations with the risk of future CVD events and the results tended to become stronger with increasing assay sensitivity. For the super-sensitivity assay the multivariate adjusted hazard ratios (per one standard deviation increase) for different outcomes were: MI 1.24 [95% CI 1.11-1.39], stroke 1.14 [1.01-1.28], CVD 1.15 [1.07-1.24], HF 1.28 [1.18-1.39], and MACE 1.18 [1.11-1.25]. In subjects with intermediate risk, we found an improvement of net reclassification for HF (10.2%, p<0.001), and MACE (5.1%, p<0.001).CONCLUSION: Using a super-sensitivity assay, cardiac troponin was detectable in almost all healthy individuals. Its concentration improved risk prediction and reclassification for cardiovascular endpoints.
AB - IMPORTANCE AND OBJECTIVE: Besides their role in diagnosis of acute myocardial infarction (MI), troponins may be powerful biomarkers for risk stratification in the general population. The objective of our study was to compare the performance of three troponin assays in cardiovascular disease (CVD) risk prediction in a population-based cohort without a history of CVD events.DESIGN, SETTING AND PARTICIPANTS: Troponin I concentrations were measured using a contemporary-sensitivity, high-sensitivity, and super-sensitivity assay in 7,899 participants of the general-population based FINRISK 1997 cohort. 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 over-optimism.MAIN OUTCOME: As outcome measures we used CVD, MI, ischemic stroke, heart failure (HF), and major adverse cardiac events (MACE). During the follow-up of 14 years 1,074 incident MACE were observed.RESULTS: Values above the lower limit of detection were observed in 26.4%, 81.5% and 93.9% for the contemporary-sensitivity, high-sensitivity and super-sensitivity assay, respectively. We observed significant associations of troponin concentrations with the risk of future CVD events and the results tended to become stronger with increasing assay sensitivity. For the super-sensitivity assay the multivariate adjusted hazard ratios (per one standard deviation increase) for different outcomes were: MI 1.24 [95% CI 1.11-1.39], stroke 1.14 [1.01-1.28], CVD 1.15 [1.07-1.24], HF 1.28 [1.18-1.39], and MACE 1.18 [1.11-1.25]. In subjects with intermediate risk, we found an improvement of net reclassification for HF (10.2%, p<0.001), and MACE (5.1%, p<0.001).CONCLUSION: Using a super-sensitivity assay, cardiac troponin was detectable in almost all healthy individuals. Its concentration improved risk prediction and reclassification for cardiovascular endpoints.
KW - Adult
KW - Aged
KW - Cardiovascular Diseases/diagnosis
KW - Endpoint Determination
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk Assessment
KW - Sensitivity and Specificity
KW - Troponin/metabolism
U2 - 10.1371/journal.pone.0090063
DO - 10.1371/journal.pone.0090063
M3 - SCORING: Journal article
C2 - 24594734
VL - 9
SP - e90063
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 3
ER -
