High-sensitivity cardiac troponin I and B-type natriuretic Peptide as predictors of vascular events in primary prevention: impact of statin therapy.

Abstract

BACKGROUND:

Cardiac troponin and B-type natriuretic peptide (BNP) concentrations are associated with adverse cardiovascular outcome in primary prevention populations. Whether statin therapy modifies this association is poorly understood.

METHODS AND RESULTS:

We measured high-sensitivity cardiac troponin I (hsTnI) in 12 956 and BNP in 11 076 participants without cardiovascular disease in the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial before randomization to rosuvastatin 20 mg/d or placebo. Nearly 92% of participants had detectable circulating hsTnI, and 2.9% of men and 4.1% of women had levels above proposed sex-specific reference limits of 36 and 15 ng/L, respectively. hsTnI concentrations in the highest tertile were associated with a first major cardiovascular event (adjusted hazard ratio [aHR], 2.19; 95% confidence interval, 1.56-3.06; P for trend <0.001). BNP levels in the highest tertile were also associated a first cardiovascular event (aHR, 1.94; 95% confidence interval, 1.41-2.68; P for trend <0.001). The risk of all-cause mortality was elevated for the highest versus the lowest tertiles of hsTnI (aHR, 2.61; 95% confidence interval, 1.81-3.78; P for trend <0.001) and BNP (aHR, 1.45; 95% confidence interval, 1.03-2.04; P for trend 0.02). Rosuvastatin was equally effective in preventing a first cardiovascular event across categories of hsTnI (aHR range, 0.50-0.60) and BNP (aHR range, 0.42-0.67) with no statistically significant evidence of interaction (P for interaction=0.53 and 0.20, respectively).

CONCLUSIONS:

In a contemporary primary prevention population, baseline cardiac troponin I and BNP were associated with the risk of vascular events and all-cause mortality. The benefits of rosuvastatin were substantial and consistent regardless of baseline hsTnI or BNP concentrations.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.

• Authors: Brendan M Everett, Tanja Zeller, Robert J Glynn, Paul M Ridker, Stefan Blankenberg
• Journal: Circulation (Circulation) Vol. 131 Issue 21 Pg. 1851-60 (May 26 2015) ISSN: 1524-4539 [Electronic] United States
• PMID: 25825410 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 The Authors.

Chemical References

• Biomarkers
• Cholesterol, HDL
• Fluorobenzenes
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pyrimidines
• Sulfonamides
• TNNT3 protein, human
• Troponin T
• Natriuretic Peptide, Brain
• Rosuvastatin Calcium

Topics

• Aged
• Angina, Unstable (epidemiology, prevention & control)
• Biomarkers
• Cholesterol, HDL (blood)
• Comorbidity
• Coronary Disease (epidemiology, prevention & control)
• Double-Blind Method
• Female
• Fluorobenzenes (pharmacology, therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (pharmacology, therapeutic use)
• Hypertension (epidemiology)
• Incidence
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Primary Prevention
• Prospective Studies
• Pyrimidines (pharmacology, therapeutic use)
• Rosuvastatin Calcium
• Stroke (epidemiology, prevention & control)
• Sulfonamides (pharmacology, therapeutic use)
• Troponin T (blood)