Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study.

Autor: Kimenai DM; British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK., Anand A; British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK., de Bakker M; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands., Shipley M; Department of Epidemiology and Public Health, University College London, London, UK., Fujisawa T; British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK., Lyngbakken MN; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Hveem K; Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway.; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway., Omland T; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.; K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Valencia-Hernández CA; Department of Epidemiology and Public Health, University College London, London, UK., Lindbohm JV; Department of Epidemiology and Public Health, University College London, London, UK.; Department of Public Health, University of Helsinki, Helsinki, Finland., Kivimaki M; Department of Epidemiology and Public Health, University College London, London, UK., Singh-Manoux A; Department of Epidemiology and Public Health, University College London, London, UK.; Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153, Université de Paris, Paris, France., Strachan FE; Usher Institute, University of Edinburgh, Edinburgh, UK., Shah ASV; Department of Non-Communicable Disease, London School of Hygiene and Tropical Medicine, London, UK., Kardys I; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands., Boersma E; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands., Brunner EJ; Department of Epidemiology and Public Health, University College London, London, UK., Mills NL; British Heart Foundation/University Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, EH16 4SA, UK. nick.mills@ed.ac.uk.; Usher Institute, University of Edinburgh, Edinburgh, UK. nick.mills@ed.ac.uk.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2023 Jun 19; Vol. 21 (1), pp. 216. Date of Electronic Publication: 2023 Jun 19.
DOI: 10.1186/s12916-023-02921-8
Abstrakt: Background: High-sensitivity cardiac troponin testing is a promising tool for cardiovascular risk prediction, but whether serial testing can dynamically predict risk is uncertain. We evaluated the trajectory of cardiac troponin I in the years prior to a cardiovascular event in the general population, and determine whether serial measurements could track risk within individuals.
Methods: In the Whitehall II cohort, high-sensitivity cardiac troponin I concentrations were measured on three occasions over a 15-year period. Time trajectories of troponin were constructed in those who died from cardiovascular disease compared to those who survived or died from other causes during follow up and these were externally validated in the HUNT Study. A joint model that adjusts for cardiovascular risk factors was used to estimate risk of cardiovascular death using serial troponin measurements.
Results: In 7,293 individuals (mean 58 ± 7 years, 29.4% women) cardiovascular and non-cardiovascular death occurred in 281 (3.9%) and 914 (12.5%) individuals (median follow-up 21.4 years), respectively. Troponin concentrations increased in those dying from cardiovascular disease with a steeper trajectory compared to those surviving or dying from other causes in Whitehall and HUNT (P interaction  < 0.05 for both). The joint model demonstrated an independent association between temporal evolution of troponin and risk of cardiovascular death (HR per doubling, 1.45, 95% CI,1.33-1.75).
Conclusions: Cardiac troponin I concentrations increased in those dying from cardiovascular disease compared to those surviving or dying from other causes over the preceding decades. Serial cardiac troponin testing in the general population has potential to track future cardiovascular risk.
(© 2023. The Author(s).)
Databáze: MEDLINE
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