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Article History

Received: 25 July 2025

Accepted: 4 December 2025

First Online: 15 January 2026

Declarations

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: This study analyzed deceased participants within the HCHS cohort; thus, no additional informed consent was required. Prior to the commencement of the study, the local ethics committee of the State of Hamburg Chamber of Medical Practitioners was consulted, and its approval for the study protocol was obtained. Additionally, the study protocol was approved by the Data Protection Commissioner of the University Medical Center of the University Hamburg-Eppendorf and the Data Protection Commissioner of the Free and Hanseatic City of Hamburg (reference number PV5131). The present study has been registered on the ClinicalTrial.gov database (NCT03934957).

: Mrs Munzinger reports speaker honoraria from Amgen, outside of the submitted work.Prof. Twerenbold reports research support from the German Center for Cardiovascular Research (DZHK), the Kühne Foundation, the Joachim Herz Foundation, the Swiss National Science Foundation (Grant No P300PB_167803) and the Swiss Heart Foundation as well as speaker honoraria/consulting honoraria from Abbott, Amgen, Astra Zeneca, Psyros, Roche, Siemens, Singulex and Thermo Scientific BRAHMS. Twerenbold is co-founder and shareholder of the ART-EMIS Hamburg GmbH, which holds an international patent application on a computing device for estimating the probability of myocardial infarction (International Publication Numbers WO2022043229A1, TW202219980A).Prof. Ondruschka and Prof. Anders-Lohner report support from NATON (National Autopsy Network, grant no. 01KX2121) as part of the Network University Medicine (NUM), which is sponsored by the Federal Ministry of Education and Research, Germany.Prof. Blankenberg has received research funding from Abbott Diagnostics, Bayer, SIEMENS, Singulex and Thermo Fisher. SB received honoraria for lectures from Abbott, Abbott Diagnostics, AstraZeneca, Bayer, AMGEN, Medtronic, Pfizer, Roche, SIEMENS Diagnostics, SIEMENS, Thermo Fisher and as member of Advisory Boards and for consulting for Bayer, Novartis and Thermo Fisher, all outside of the submitted work.Dr. Becher reports personal fees from AstraZeneca, Ingelheim Boehringer and the German Research Foundation. All outside the submitted work. All other authors declare no competing interests.All other authors do not report any competing interest related to the submitted work.