Cardiac Troponin and its Relationship to Cardiovascular Outcomes in Community Populations – A Systematic Review and Meta-analysis Julie Sze, MBBS, John.

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Cardiac Troponin and its Relationship to Cardiovascular Outcomes in Community Populations – A Systematic Review and Meta-analysis Julie Sze, MBBS, John Mooney, MBBS, Federica Barzi, PhD, Graham S. Hillis, MBChB, PhD, Clara K. Chow, MBBS, PhD Heart, Lung and Circulation Volume 25, Issue 3, Pages 217-228 (March 2016) DOI: 10.1016/j.hlc.2015.09.001 Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 1 Flow Diagram. Heart, Lung and Circulation 2016 25, 217-228DOI: (10.1016/j.hlc.2015.09.001) Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 2 Adjusted* relative risk (RR) of cardiovascular events and all-cause mortality associated with troponin greater than the 99th percentile reference value of a healthy reference population versus undetected troponin at baseline. *Adjusted for age, gender and race, smoking status, BMI, presence of diabetes mellitus, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive medication use. Additional adjustments include: Saunders: hs-CRP, BNP and eGFR. deFilippi: CVD mortality model- coronary heart disease, CRP, NT-proBNP. HF model - albumin and creatinine concentration coronary heart disease, heart rate, and left ventricle hypertrophy on electrocardiogram. de Lemos: hs-CRP, GFR, NT-proBNP. Leistner: hscRP, NT-proBNP,eGFR. Sundstrom: previous myocardial infarction (MI), MI during follow up, NT-proBNP. Zethelius: lipid lowering treatment Heart, Lung and Circulation 2016 25, 217-228DOI: (10.1016/j.hlc.2015.09.001) Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 3 Adjusted* relative risk (RR) for cardiovascular mortality in individuals with detectable troponin levels versus individuals with undetectable levels. * Adjusted for age, gender and race, smoking status, BMI, presence of diabetes mellitus, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive medication use. Additional adjustments included: Everett: BMI, history of MI, hsCRP, NT-BNP, GFR. Daniels: BMI, heart rate, physical activity, and creatinine clearance, baseline CHD. Heart, Lung and Circulation 2016 25, 217-228DOI: (10.1016/j.hlc.2015.09.001) Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 4 Adjusted relative risk (RR) of adverse outcome stratified by troponin categorisation (increasing troponin levels). Heart, Lung and Circulation 2016 25, 217-228DOI: (10.1016/j.hlc.2015.09.001) Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions