TY - JOUR
T1 - Cardiac Troponin I and Incident Stroke in European Cohorts
T2 - Insights From the BiomarCaRE Project
AU - BiomarCaRE Consortium
AU - Camen, Stephan
AU - Palosaari, Tarja
AU - Reinikainen, Jaakko
AU - Sprünker, Ngoc Anh
AU - Niiranen, Teemu
AU - Gianfagna, Francesco
AU - Vishram-Nielsen, Julie K. K.
AU - Costanzo, Simona
AU - Söderberg, Stefan
AU - Palmieri, Luigi
AU - Ferrario, Marco
AU - Peters, Annette
AU - Vartiainen, Erkki
AU - Donati, Maria Benedetta
AU - Donfrancesco, Chiara
AU - Borchini, Rossana
AU - Börschel, Christin Susanna
AU - Giampaoli, Simona
AU - Di Castelnuovo, Augusto
AU - Magnussen, Christina
AU - Kee, Frank
AU - Koenig, Wolfgang
AU - Blankenberg, Stefan
AU - de Gaetano, Giovanni
AU - Tunstall-Pedoe, Hugh
AU - Rospleszcz, Susanne
AU - Jørgensen, Torben
AU - Zeller, Tanja
AU - Kuulasmaa, Kari
AU - Linneberg, Allan
AU - Salomaa, Veikko
AU - Iacoviello, Licia
AU - Schnabel, Renate B.
N1 - The BiomarCaRE (Biomarkers for Cardiovascular Risk Assessment in Europe) Project is funded by the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement No. HEALTH-F2-2011-278913. Dr Schnabel has received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 648131), from the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 847770; AFFECT-EU), and the German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103), German Federal Ministry of Research and Education (BMBF; 01ZX1408A) and ERACoSysMed3 (031L0239). The activities of the MONICA Risk, Genetics, Archiving and Monograph (MORGAM) Data Center have been sustained by recent funding from the European Union FP 7 project CHANCES (HEALTH-F3-2010-242244). The MORGAM Biomarker Study (Serum Biomarkers in the MORGAM Populations) has further received funding from the Medical Research Council London (G0601463, No. 80983). The KORA study (Cooperative Health Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München–German Research Center for Environmental Health, which is funded by the BMBF and by the State of Bavaria. Furthermore, KORA research was supported within the Munich Center of Health Sciences, Ludwig-Maximilians-Universität, as part of LMUinnovativ. The FINRISK surveys were mainly supported by budgetary funds of THL with additional funding from numerous nonprofit foundations. Dr Salomaa (principal investigator) has been supported by the Finnish Foundation for Cardiovascular Research and the Academy of Finland (139635). Dr Niiranen has been supported by the Finnish Medical Foundation, the Emil Aaltonen Foundation, the Paavo Nurmi Foundation, and the Academy of Finland (321351). The DanMONICA cohorts at the Research Center for Prevention and Health were established over a period of 10 years and have been funded by numerous sources, which have been acknowledged, where appropriate, in the original articles. The MATISS Project was partly supported by the National Research Council, by the Istituto Superiore di Sanità-ISS (1984, 1987,1993-1996) and by the Ministry of Health (1998). The Moli-sani Project was partially supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (Rome, Italy)–Programma Triennale di Ricerca, Decreto n.1588, and Instrumentation Laboratory, Milan, Italy. The Northern Sweden MONICA project was supported by the Norrbotten and Västerbotten County councils. Dr Söderberg has been supported by the Swedish Heart-Lung Foundation (20140799, 20120631, and 20100635), the County Council of Västerbotten (ALF, VLL-548791), and Umeå University. The SHHEC (Scottish Heart Health Extended Cohort) received funding from the Scottish Health Department Chief Scientist Organization, the British Heart Foundation, and the FP Fleming Trust.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background and Purpose: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce.Methods: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. 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 overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries.Results: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021).Conclusions: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.
AB - Background and Purpose: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce.Methods: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. 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 overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries.Results: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021).Conclusions: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.
KW - cohort studies
KW - epidemiology
KW - risk assessment
KW - stroke
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85089922353&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.029452
DO - 10.1161/STROKEAHA.120.029452
M3 - Article
C2 - 32811388
SN - 0039-2499
VL - 51
SP - 2770
EP - 2777
JO - Stroke
JF - Stroke
IS - 9
ER -