title: Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study.
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.
authors.affiliation: UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland; maria.hughes@qub.ac.uk.|Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel.|MRC Epidemiology Unit, University of Cambridge, United Kingdom.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Hughes
authors.affiliation: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ojeda
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|National Institute for Health and Welfare THL, Helsinki, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Saarela
authors.affiliation: Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark.|Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.|Faculty of Medicine, University of Aalborg, Aalborg, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
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.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: National Institute for Health and Welfare THL, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Palosaari
authors.affiliation: UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland.
authors.forename: Mark G
authors.initials: MG
authors.lastname: O'Doherty
authors.affiliation: Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Borglykke
authors.affiliation: National Institute for Health and Welfare THL, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
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.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I