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

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

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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

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

Associated data

  • ClinicalTrials.gov/NCT00239681