Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.
Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.
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DOI：
10.1093/eurheartj/ehw172
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发表时间：
2016-08-07
影响因子：
39.3
通讯作者：
BiomarCaRE Investigators
中科院分区：
文献类型：
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作者：
Blankenberg S;Salomaa V;Makarova N;Ojeda F;Wild P;Lackner KJ;Jørgensen T;Thorand B;Peters A;Nauck M;Petersmann A;Vartiainen E;Veronesi G;Brambilla P;Costanzo S;Iacoviello L;Linden G;Yarnell J;Patterson CC;Everett BM;Ridker PM;Kontto J;Schnabel RB;Koenig W;Kee F;Zeller T;Kuulasmaa K;BiomarCaRE Investigators
我们的目的是评估肌钙蛋白I浓度在整个欧洲人群队列中的分布，表征其与心血管结局的关联，确定ESC SCORE中使用的变量之外的预测值，测试潜在的临床相关临界值，并回顾性评估基于肌钙蛋白I浓度升高的他汀类药物治疗的改善资格。基于欧洲心血管风险评估生物标志物（Biomarkers for Cardiovascular Risk Assessment, BiomarCaRE）项目，我们分析了10项前瞻性人群研究的个人水平数据，包括74 738名参与者。我们通过计算判别指标（c指数）和净重分类改善（NRI），研究了将肌钙蛋白I水平加入常规危险因素对预测心血管疾病的价值。在JUPITER研究中，我们进一步测试了12956名无心血管疾病的人基于肌钙蛋白浓度的他汀类药物治疗的临床意义。肌钙蛋白I仍然是一个独立的预测因子，心血管死亡率的风险比为1.37，心血管疾病的风险比为1.23，总死亡率的风险比为1.24。将肌钙蛋白I信息添加到由ESC SCORE变量构建的心血管死亡预测模型中，可使c -指数判别值提高0.007，NRI为0.048，而添加到心血管疾病和总死亡率的预测模型中，可使c -指数判别值降低，并使NRI增加。在肌钙蛋白I浓度高于6 ng/L的个体中，接近生物护理（5.9 ng/L）和木星（5.8 ng/L）的上五分之一浓度，瑞舒伐他汀治疗与肌钙蛋白I浓度<6 ng/L的个体相比，绝对风险降低更高，而相对风险降低相似。在无心血管疾病的个体中，将肌钙蛋白I添加到已建立的风险评分变量中可以提高对心血管死亡和心血管疾病的预测。
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.