{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:00:06Z","timestamp":1770897606858,"version":"3.50.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82\u2009881 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              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\u20131.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09\u20131.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01\u20131.20]). 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%\u201320%), the net reclassification improvement for overall stroke was 0.038 (\n              <jats:italic>P<\/jats:italic>\n              =0.021).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.120.029452","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T18:01:31Z","timestamp":1598292091000},"page":"2770-2777","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Cardiac Troponin I and Incident Stroke in European Cohorts"],"prefix":"10.1161","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-9208","authenticated-orcid":true,"given":"Stephan","family":"Camen","sequence":"first","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."},{"name":"German Center for Cardiovascular Research, Partner Site Hamburg\/Kiel\/Luebeck (S.C., C.S., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-3516","authenticated-orcid":true,"given":"Tarja","family":"Palosaari","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaakko","family":"Reinikainen","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngoc Anh","family":"Spr\u00fcnker","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7394-7487","authenticated-orcid":true,"given":"Teemu","family":"Niiranen","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."},{"name":"Department of Medicine, Turku University Hospital and University of Turku, Finland (T.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4615-0816","authenticated-orcid":true,"given":"Francesco","family":"Gianfagna","sequence":"additional","affiliation":[{"name":"Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G., M.F., R.B., L.I.)."},{"name":"Mediterranea Cardiocentro, Napoli, Italy (F.G., A.D.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1762-7750","authenticated-orcid":true,"given":"Julie K.K.","family":"Vishram-Nielsen","sequence":"additional","affiliation":[{"name":"Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Copenhagen (J.K.K.V.-N., T.J., A.L.)."},{"name":"Department of Cardiology, Rigshospitalet (J.K.K.V.-N.), University of Copenhagen, Denmark."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4569-1186","authenticated-orcid":true,"given":"Simona","family":"Costanzo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy (S. Costanzo, M.B.D., G.d.G., L.I.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9225-1306","authenticated-orcid":true,"given":"Stefan","family":"S\u00f6derberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine and Heart Centre, Ume\u00e5 University, Sweden (S.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanit\u00e0-ISS, Rome, Italy (L.P., C.D., S.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Ferrario","sequence":"additional","affiliation":[{"name":"Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G., M.F., R.B., L.I.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6645-0985","authenticated-orcid":true,"given":"Annette","family":"Peters","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Helmholtz Zentrum M\u00fcnchen\u2013German Research Center for Environmental Health, Neuherberg (A.P., S.R.)."},{"name":"Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, M\u00fcnchen, Germany (A.P., S.R.)."},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7498-4389","authenticated-orcid":true,"given":"Erkki","family":"Vartiainen","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Benedetta","family":"Donati","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy (S. Costanzo, M.B.D., G.d.G., L.I.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Donfrancesco","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanit\u00e0-ISS, Rome, Italy (L.P., C.D., S.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossana","family":"Borchini","sequence":"additional","affiliation":[{"name":"Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G., M.F., R.B., L.I.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christin Susanna","family":"B\u00f6rschel","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Giampaoli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanit\u00e0-ISS, Rome, Italy (L.P., C.D., S.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9767-7998","authenticated-orcid":true,"given":"Augusto","family":"Di Castelnuovo","sequence":"additional","affiliation":[{"name":"Mediterranea Cardiocentro, Napoli, Italy (F.G., A.D.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Magnussen","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."},{"name":"German Center for Cardiovascular Research, Partner Site Hamburg\/Kiel\/Luebeck (S.C., C.S., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Kee","sequence":"additional","affiliation":[{"name":"Centre for Public Health, Queens University of Belfast, United Kingdom (F.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Koenig","sequence":"additional","affiliation":[{"name":"German Heart Center Munich, Technical University of Munich, Germany (W.K.)."},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., A.P.)."},{"name":"Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."},{"name":"German Center for Cardiovascular Research, Partner Site Hamburg\/Kiel\/Luebeck (S.C., C.S., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"de Gaetano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy (S. Costanzo, M.B.D., G.d.G., L.I.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Tunstall-Pedoe","sequence":"additional","affiliation":[{"name":"Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom (H.T.-P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Rospleszcz","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Helmholtz Zentrum M\u00fcnchen\u2013German Research Center for Environmental Health, Neuherberg (A.P., S.R.)."},{"name":"Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, M\u00fcnchen, Germany (A.P., S.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9453-2830","authenticated-orcid":true,"given":"Torben","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Copenhagen (J.K.K.V.-N., T.J., A.L.)."},{"name":"Department of Public Health, Faculty of Health and Medical Sciences (T.J.), University of Copenhagen, Denmark."},{"name":"Faculty of Medicine, Aalborg University, Denmark (T.J.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Zeller","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg, Clinic for Cardiology, Germany (S.C., N.A.S., C.B., C.M., S.B., T.Z., R.B.S.)."},{"name":"German Center for Cardiovascular Research, Partner Site Hamburg\/Kiel\/Luebeck (S.C., C.S., C.M., S.B., T.Z., R.B.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2165-1411","authenticated-orcid":true,"given":"Kari","family":"Kuulasmaa","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Linneberg","sequence":"additional","affiliation":[{"name":"Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Copenhagen (J.K.K.V.-N., T.J., A.L.)."},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences (A.L.), University of Copenhagen, Denmark."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7563-5324","authenticated-orcid":true,"given":"Veikko","family":"Salomaa","sequence":"additional","affiliation":[{"name":"Finnish Institute for Health and Welfare, Helsinki, Finland (T.P., J.R., T.N., E.V., K.K., V.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Licia","family":"Iacoviello","sequence":"additional","affiliation":[{"name":"Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G., M.F., R.B., L.I.)."},{"name":"Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy (S. 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Description of MORGAM Cohorts [Internet]. 2005. https:\/\/www.thl.fi\/publications\/morgam\/cohorts\/index.html. Accessed May 4 2019."},{"key":"e_1_3_5_14_2","first-page":"67","article-title":"Mice: multivariate imputation by chained equations in R.","volume":"45","author":"van Buuren S","year":"2011","unstructured":"van Buuren, S, Groothuis-Oudshoorn, K. Mice: multivariate imputation by chained equations in R. 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