title: Circulating troponin as measured by a sensitive assay for cardiovascular risk assessment in primary prevention.
abstract: BACKGROUND
  Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention.
  
  
  METHODS
  We measured circulating concentrations of cTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up.
  
  
  RESULTS
  Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP.
  
  
  CONCLUSIONS
  Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.
authors.affiliation: Department of Medicine III, Cardiology, Goethe-University Frankfurt, Germany.
authors.forename: David M
authors.initials: DM
authors.lastname: Leistner
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.forename: Lars
authors.initials: L
authors.lastname: Pieper
authors.forename: Günter K
authors.initials: GK
authors.lastname: Stalla
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011322:Primary Prevention; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein