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Circulation. 2015 May 26;131(21):1851-60. doi: 10.1161/CIRCULATIONAHA.114.014522. Epub 2015 Mar 30.

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

Author information

1
From Divisions of Cardiovascular (B.M.E., P.M.R.) and Preventive Medicine (B.M.E., R.J.G., P.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Germany (T.Z., S.B.); and German Centre for Cardiovascular Research Partner Site Hamburg/Lübeck/Kiel, Germany (T.Z., S.B.). beverett@partners.org.
2
From Divisions of Cardiovascular (B.M.E., P.M.R.) and Preventive Medicine (B.M.E., R.J.G., P.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Germany (T.Z., S.B.); and German Centre for Cardiovascular Research Partner Site Hamburg/Lübeck/Kiel, Germany (T.Z., S.B.).

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.

KEYWORDS:

hydroxymethylglutaryl-CoA reductase inhibitors; natriuretic peptide, brain; primary prevention; troponin

PMID:
25825410
PMCID:
PMC4444427
DOI:
10.1161/CIRCULATIONAHA.114.014522
[Indexed for MEDLINE]
Free PMC Article

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