title: Comparison of three troponins as predictors of future cardiovascular events--prospective results from the FINRISK and BiomaCaRE studies.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Using a super-sensitivity assay, cardiac troponin was detectable in almost all healthy individuals. Its concentration improved risk prediction and reclassification for cardiovascular endpoints.
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Johannes Tobias
authors.initials: JT
authors.lastname: Neumann
authors.affiliation: National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.
authors.forename: Aki S
authors.initials: AS
authors.lastname: Havulinna
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Appelbaum
authors.affiliation: Department of Medical Biochemistry, University of Tampere Medical School, Tampere, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Kunnas
authors.affiliation: Department of Medical Biochemistry, University of Tampere Medical School, Tampere, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Nikkari
authors.affiliation: National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jousilahti
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Sydow
authors.affiliation: National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014336:Troponin / Q000378:metabolism*
chemical_list: D014336:Troponin