@article{87ef3ac07bb14993b9578ec2bbecb125,
title = "Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study",
abstract = "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.",
keywords = "Biomarkers, Cardiovascular Diseases/diagnosis, Cohort Studies, Female, Humans, Longitudinal Studies, Male, Risk Factors, Troponin I",
author = "Kimenai, {Dorien M.} and Atul Anand and {De Bakker}, Marie and Martin Shipley and Takeshi Fujisawa and Lyngbakken, {Magnus N.} and Kristian Hveem and Torbj{\o}rn Omland and Valencia-Hern{\'a}ndez, {Carlos A.} and Lindbohm, {Joni V.} and Mika Kivimaki and Archana Singh-Manoux and Strachan, {Fiona E.} and Shah, {Anoop S. V.} and Isabella Kardys and Eric Boersma and Brunner, {Eric J.} and Mills, {Nicholas l.}",
note = "Funding Information: The Whitehall II Study has been supported by grants from the British Medical Research Council; British Economic and Social Research Council; British Heart Foundation (RG/16/11/32334); United Kingdom Health and Safety Executive; United Kingdom Department of Health; National Heart Lung and Blood Institute (HL36310), National Institutes of Health; National Institute on Aging R01AG056477, RF1AG062553), National Institutes of Health; Agency for Health Care Policy Research (HS06516); and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. United Kingdom Stroke Association; United Kingdom Health and Safety Executive. The study was supported by an investigator-initiated study grant from the Siemens Healthineers to the University of Edinburgh. DMK is supported by Health Data Research UK which receives its funding from HDR UK Ltd (HDR-5012) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust. EJB{\textquoteright}s research is supported by UKRI (ES/T014377/1). ASVS is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/19/17/34172). NLM is supported by a Chair Award (CH/F/21/90010), a Programme Grant (RG/20/10/34966) and a Research Excellence Award (RE/18/5/34216) from the British Heart Foundation. The cardiac troponin I mesurements in HUNT were supported by an investigator-initiated study grant from Abbott Diagnostics to the Akershus University Hospital. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in the study design, statistical analysis or decision to submit this work to be considered for publication. Funding Information: The authors gratefully acknowledge the BHF Cardiovascular Biomarker Laboratory, the University of Edinburgh for their expertise & assistance in this work. The Tr{\o}ndelag Health (HUNT) Study is a collaboration between HUNT Research Centre, (Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology), Tr{\o}ndelag County Council, Central Norway Regional Health Authority, and the Norwegian Institute of Public Health. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = jun,
day = "19",
doi = "10.1186/s12916-023-02921-8",
language = "English",
volume = "21",
pages = "216",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",
}