BioRemarkable Symposium

Transcription

1 Autor Kurztitel der Präsentation Nr. 1 BioRemarkable Symposium The Use of High/Ultra Sensitivity Troponin as Cardiac Risk Marker in the Population Stefan Blankenberg University Heart Center Hamburg London, September 7th, 2017 Universitätsklinikum Hamburg-Eppendorf

2 Autor Kurztitel der Präsentation Nr. 2

3 Autor Kurztitel der Präsentation Nr. 3 To evaluate the association of high sensitivity troponin I and incident cardiovascular events in the general population To test whether high sensitivity troponin I improves cardiovascular risk prediction To test the impact of high sensitivity troponin I on therapy interaction and potential selection

4 Autor Kurztitel der Präsentation Nr. 4 PAR (%) modifiable risk factors are responsible for 90% of myocardial infarction Smoking Fruits/ veg Exercise Alcohol Hypertension Diabetes Abdominal Psychosocial obesity Lipids All 9 risk factors Lifestyle factors n = 15,152 patients and 14,820 controls in 52 countries PAR = population attributable risk, adjusted for all risk factors Yusuf S et al. Lancet 2004; 364:937-52

5 Autor Kurztitel der Präsentation Nr. 5 Setting the bar high!

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7 Autor Kurztitel der Präsentation Nr. 7 FINRISK n = 8000 PRIME n= years risk sensitive Troponin I CRP Nt-proBNP Blankenberg S for the MORGAM Investigators Circulation 2010

8 Autor Kurztitel der Präsentation Nr. 8 Blankenberg S for the MORGAM Investigators Circulation 2010

9 Autor Kurztitel der Präsentation Nr. 9 Blankenberg S for the MORGAM Investigators Circulation 2010

10 Troponin I and the General Population

11 Troponin I and the General Population

12 Troponin I and the General Population

13 Troponin I and the General Population

14 BiomarCaRE The Cohorts Autor Kurztitel der Präsentation Nr. 14 primary prevention population cohorts secondary prevention disease cohorts clinical trials cohorts

15 Troponin I and cardiovascular risk prediction in the general population - The BiomarCaRE Consortium 10 cohorts About 90,000 individuals 5 European countries 74,738 available measurements of troponin I Evaluation of distribution of troponin I Characterization of association with cardiovascular mortality, cardiovascular event, and overall mortality Determination of the predictive value Testing of the potential clinical relevance of cut-off value Evaluation of eligibility for statin therapy

16 Troponin and outcome in the population

17 Troponin and outcome in the population

18 Table: Changes in C-statistics for ten-year risk prediction of cardiovascular disease after adding of continuous troponin I to a established risk score in the overall cohort and according to age groups ESC SCORE C-index (95% CI) ESC SCORE C-index difference (95% CI) P-value All 0.80 (0.79, 0.81) (0.003, 0.005) < < (0.79, 0.87) (-0.002, 0.004) (0.72, 0.77) (0.002, 0.009) < (0.67, 0.71) (0.004, 0.009) < (0.62, 0.67) (0.012, 0.024) < 0.001

19 J Am Coll Cardiol Aug 1; 70(5): doi: /j.jacc PMCID: PMC High-Sensitivity Cardiac Troponin Concentration and Risk of First- Ever Cardiovascular Outcomes in 154,052 Participants Peter Willeit, MD, MPhil, PhD, a,b, Paul Welsh, PhD, c Jonathan D.W. Evans, MBChB, b,d Lena Tschiderer, Dipl-Ing, BSc, a Charles Boachie, BSc, c J. Wouter Jukema, MD, PhD, e Ian Ford, PhD, f Stella Trompet, PhD, g David J. Stott, MD, c Patricia M. Kearney, MD, PhD, h Simon P. Mooijaart, MD, PhD, g Stefan Kiechl, MD, a Emanuele Di Angelantonio, MD, MSc, PhD, b,i,j,k and Naveed Sattar, MD, PhD c

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21 Figure 2

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23 Rosuvastatin and Cumulative Incidence of Cardiovascular Events JUPITER Ridker et al. NEJM 2008

24 LoD hstni in JUPITER

25 hstni in JUPITER N Median (IQR), ng/l N (%) with detectable* hstni All participants 12, ( ) 11,912 (91.9) Men 8, ( ) 7,748 (93.8) Women 4, ( ) 4,164 (88.6) * LoD hstni 1.9 ng/l N N with elevated hstni Percent All participants 12, Men 8, Women 4, hstni 15 ng/l women and 36 ng/l men Appel et al Clin Chem

26 Risk of Primary Endpoint According to Baseline hstni Model 1 Model 2 Model 3 HR (95% CI) 2.27 ( ) P < HR (95% CI) 1.13 ( ) P < Tertile 1 Tertile 2 Tertile 3 N events/person years of observation 48/ / /9638 Rate per 100 py Per 1-SD increase in ln(hstni)

27 Risk Reduction by hstni Category at Baseline Rosuvastatin Placebo hstni tertile N events Incidence Rate* N events Incidence Rate* Absolute Risk Reduction* Hazard Ratio (95% CI) P-value ( ) ( ) ( ) < * Per 100 person-years of follow up Adjusted for age, race, BMI, history of hypertension, current smoking, family history of MI, total cholesterol, HDL cholesterol, hscrp

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34 Troponin I and Cardiovascular Risk Prediction in the General Population - Improving risk prediction in healthy individuals drawn from the general population The addition of troponin I might be particularly helpful in those above 65 years of age Troponin I determination might support the selection of those individuals, who would benefit most from preventive strategies

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