High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort

• Published in: European heart journal Vol. 35; no. 5; pp. 271 - 281
• Main Authors: Zeller, Tanja, Tunstall-Pedoe, Hugh, Saarela, Olli, Ojeda, Francisco, Schnabel, Renate B, Tuovinen, Tarja, Woodward, Mark, Struthers, Allan, Hughes, Maria, Kee, Frank, Salomaa, Veikko, Kuulasmaa, Kari, Blankenberg, Stefan
• Format: Journal Article
• Language: English
• Published: England 01.02.2014
• Subjects: Biomarkers - blood; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cohort Studies; Female; Humans; Immunoassay - methods; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - mortality; Prevalence; Risk Assessment; Scotland - epidemiology; Sex Distribution; Stroke - blood; Stroke - mortality; Troponin I - blood; Scotland; High-sensitivity assayed troponin I; MONICA Risk Genetics Archiving and Monograph (MORGAM); Mortality; Cardiovascular risk; Scottish Heart Health Extended Cohort (SHHEC)
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/eht406

Our aim was to test the prediction and clinical applicability of high-sensitivity assayed troponin I for incident cardiovascular events in a general middle-aged European population. High-sensitivity assayed troponin I was measured in the Scottish Heart Health Extended Cohort (n = 15 340) with 2171 cardiovascular events (including acute coronary heart disease and probable ischaemic strokes), 714 coronary deaths (25% of all deaths), 1980 myocardial infarctions, and 797 strokes of all kinds during an average of 20 years follow-up. Detection rate above the limit of detection (LoD) was 74.8% in the overall population and 82.6% in men and 67.0% in women. Troponin I assayed by the high-sensitivity method was associated with future cardiovascular risk after full adjustment such as that individuals in the fourth category had 2.5 times the risk compared with those without detectable troponin I (P < 0.0001). These associations remained significant even for those individuals in whom levels of contemporary-sensitivity troponin I measures were not detectable. Addition of troponin I levels to clinical variables led to significant increases in risk prediction with significant improvement of the c-statistic (P < 0.0001) and net reclassification (P < 0.0001). A threshold of 4.7 pg/mL in women and 7.0 pg/mL in men is suggested to detect individuals at high risk for future cardiovascular events. Troponin I, measured with a high-sensitivity assay, is an independent predictor of cardiovascular events and might support selection of at risk individuals.