title: Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.
abstract: Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively.
  
  
  
  Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar.
  
  
  
  In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of cardiovascular death and cardiovascular disease.
authors.affiliation: University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany s.blankenberg@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
authors.affiliation: University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Makarova
authors.affiliation: University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.affiliation: Department of Medicine II, Preventive Cardiology and Preventive Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany University Medical Center of the Johannes Gutenberg-University Mainz, Center for Thrombosis and Haemostasis (CTH), Mainz, Germany German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wild
authors.affiliation: University Medical Center Mainz, Institute for Clinical Chemistry and Laboratory Medicine, Mainz, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark Research Centre for Prevention and Health, Capital Region, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Thorand
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, München, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, München, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.affiliation: University Medicine Greifswald, Institute for Clinical Chemistry and Laboratory Medicine, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.affiliation: University Medicine Greifswald, Institute for Clinical Chemistry and Laboratory Medicine, Greifswald, Germany German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Petersmann
authors.affiliation: Chronic Disease Epidemiology and Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Vartiainen
authors.affiliation: Department of Clinical and Experimental Medicine, Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Department of Laboratory Medicine, Hospital of Desio, University of Milano Bicocca, Desio (MB), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Brambilla
authors.affiliation: IRCCS Istituto Neurologico Mediterraneo Neuromed, Department of Epidemiology and Prevention, Laboratory of Molecular and Nutritional Epidemiology, Pozzilli, Isernia, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Costanzo
authors.affiliation: IRCCS Istituto Neurologico Mediterraneo Neuromed, Department of Epidemiology and Prevention, Laboratory of Molecular and Nutritional Epidemiology, Pozzilli, Isernia, Italy.
authors.forename: Licia
authors.initials: L
authors.lastname: Iacoviello
authors.affiliation: Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK.
authors.forename: Gerard
authors.initials: G
authors.lastname: Linden
authors.affiliation: Queens University of Belfast, Centre for Public Health Belfast, Belfast, UK.
authors.forename: John
authors.initials: J
authors.lastname: Yarnell
authors.affiliation: Queens University of Belfast, Centre for Public Health Belfast, Belfast, UK.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Patterson
authors.affiliation: Brigham and Women's Hospital, Cardiovascular and Preventive Medicine Divisions, Boston, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Everett
authors.affiliation: Brigham and Women's Hospital, Cardiovascular and Preventive Medicine Divisions, Boston, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Kontto
authors.affiliation: University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.affiliation: German Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, München, Germany University of Ulm Medical Centre, Department of Internal Medicine II-Cardiology, Ulm, Germany German Heart Centre Munich, Technical University of Munich, München, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.affiliation: University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany German Center for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
mesh_terms: D015415:Biomarkers; D002318:Cardiovascular Diseases; D005060:Europe; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019210:Troponin I
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Biomarker for Cardiovascular Risk Assessment in Europe; Cardiovascular risk; High-sensitivity assayed troponin I; MONICA Risk Genetics Archiving and Monograph; Mortality