Maria F Hughes1,2,3,4, Francisco Ojeda2, Olli Saarela5,6, Torben Jørgensen7,8,9, Tanja Zeller2,3, Tarja Palosaari6, Mark G O'Doherty10, Anders Borglykke7, Kari Kuulasmaa6, Stefan Blankenberg2,3, Frank Kee10. 1. UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland; maria.hughes@qub.ac.uk. 2. Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany. 3. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel. 4. MRC Epidemiology Unit, University of Cambridge, United Kingdom. 5. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 6. National Institute for Health and Welfare THL, Helsinki, Finland. 7. Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark. 8. Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. 9. Faculty of Medicine, University of Aalborg, Aalborg, Denmark. 10. UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland.
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.
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.
Authors: Henning Jansen; Andrea Jaensch; Ben Schöttker; Dhayana Dallmeier; Roman Schmucker; Hermann Brenner; Wolfgang Koenig; Dietrich Rothenbacher Journal: J Am Heart Assoc Date: 2019-06-13 Impact factor: 5.501
Authors: Chris J Watson; Joe Gallagher; Mark Wilkinson; Adam Russell-Hallinan; Isaac Tea; Stephanie James; James O'Reilly; Eoin O'Connell; Shuaiwei Zhou; Mark Ledwidge; Ken McDonald Journal: J Transl Med Date: 2021-02-09 Impact factor: 5.531
Authors: Martin Rehm; Gisela Büchele; Raphael Simon Peter; Rolf Erwin Brenner; Klaus-Peter Günther; Hermann Brenner; Wolfgang Koenig; Dietrich Rothenbacher Journal: PLoS One Date: 2020-12-02 Impact factor: 3.240
Authors: David Stevens; Deirdre A Lane; Stephanie L Harrison; Gregory Y H Lip; Ruwanthi Kolamunnage-Dona Journal: BMC Med Res Methodol Date: 2021-12-18 Impact factor: 4.615
Authors: Paolo Morfino; Alberto Aimo; Vincenzo Castiglione; Giuseppe Vergaro; Michele Emdin; Aldo Clerico Journal: J Cardiovasc Dev Dis Date: 2022-08-10
Authors: Nina Fluschnik; Francisco Ojeda; Tanja Zeller; Torben Jørgensen; Kari Kuulasmaa; Peter Moritz Becher; Christoph Sinning; Stefan Blankenberg; Dirk Westermann Journal: PLoS One Date: 2018-05-17 Impact factor: 3.240