High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants

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dc.contributor.authorWilleit, Peter
dc.contributor.authorWelsh, Paul
dc.contributor.authorEvans, Jonathan D. W.
dc.contributor.authorTschiderer, Lena
dc.contributor.authorBoachie, Charles
dc.contributor.authorJukema, J. Wouter
dc.contributor.authorFord, Ian
dc.contributor.authorTrompet, Stella
dc.contributor.authorStott, David J.
dc.contributor.authorKearney, Patricia M.
dc.contributor.authorMooijaart, Simon P.
dc.contributor.authorKiechl, Stefan
dc.contributor.authorDi Angelantonio, Emanuele
dc.contributor.authorSattar, Naveed
dc.contributor.funderBHF Centre of Research Excellence, Oxford
dc.contributor.funderStandortagentur Tirol
dc.contributor.funderWirtschaftsagentur Wien
dc.contributor.funderBundesministerium für Wissenschaft, Forschung und Wirtschaft
dc.contributor.funderÖsterreichische Forschungsförderungsgesellschaft
dc.contributor.funderAustrian Science Fund
dc.contributor.funderChief Scientist Office
dc.date.accessioned2017-09-26T11:39:21Z
dc.date.available2017-09-26T11:39:21Z
dc.date.issued2017
dc.description.abstractBACKGROUND High-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury. OBJECTIVES The goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies. METHODS A search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis. RESULTS A total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027). CONCLUSIONS In the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke. (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.en
dc.description.sponsorshipAustrian Science Fund (ErwinSchrodinger-Fellowship (J-3679-B13); Österreichische Forschungsförderungsgesellschaft (BMVIT (843536); Chief Scientist Office (ASM/14/1)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationWilleit, P., Welsh, P., Evans, J. D. W., Tschiderer, L., Boachie, C., Jukema, J. W., Ford, I., Trompet, S., Stott, D. J., Kearney, P. M., Mooijaart, S. P., Kiechl, S., Di Angelantonio, E. and Sattar, N. (2017) 'High-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participants', Journal of the American College of Cardiology, 70(5), (11pp). doi: 10.1016/j.jacc.2017.05.062en
dc.identifier.doi10.1016/j.jacc.2017.05.062
dc.identifier.endpage568
dc.identifier.issn0735-1097
dc.identifier.issn1558-3597
dc.identifier.issued5
dc.identifier.journaltitleJournal of the American College of Cardiologyen
dc.identifier.startpage558
dc.identifier.urihttps://hdl.handle.net/10468/4799
dc.identifier.volume70
dc.language.isoenen
dc.publisherElsevier Science Inc.en
dc.relation.urihttp://www.sciencedirect.com/science/article/pii/S0735109717376878
dc.rights© 2017, the Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC by license (http://creativecommons.org/licenses/by/4.0/).en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectBiomarkeren
dc.subjectCardiovascular diseaseen
dc.subjectCoronary heart diseaseen
dc.subjectPrimary preventionen
dc.subjectStrokeen
dc.subjectSystematic reviewen
dc.subjectCoronary heart diseaseen
dc.subjectC reactive proteinen
dc.subjectNatriuretic peptideen
dc.subjectGeneral populationen
dc.subjectMyocardial infarctionen
dc.subjectAtherosclerosis risken
dc.subjectElderly populationen
dc.subjectPrimary preventionen
dc.subjectArtery diseaseen
dc.subjectStatin therapyen
dc.titleHigh-sensitivity cardiac troponin concentration and risk of first-ever cardiovascular outcomes in 154,052 participantsen
dc.typeArticle (peer-reviewed)en
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