TY - JOUR

T1 - Cardiac Troponin I and Incident Stroke in European Cohorts

T2 - Insights From the BiomarCaRE Project

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.

AU - BiomarCaRE Consortium

PY - 2020

Y1 - 2020

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

U2 - 10.1161/STROKEAHA.120.029452

DO - 10.1161/STROKEAHA.120.029452

M3 - Journal article

C2 - 32811388

AN - SCOPUS:85089922353

VL - 51

SP - 2770

EP - 2777

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -