Abstract 15969: Cardiac Troponin I as Detected by a Novel High-Sensitivity Assay Predicts Vascular Events in the JUPITER Trial
Background: Whether novel, high sensitivity assays for cardiac troponin I predict adverse cardiovascular outcome in primary prevention populations has not been well studied.
Methods and Results: We measured baseline circulating cardiac troponin I (hsTnI) with a novel high-sensitivity assay in 11,369 male and female participants in the JUPITER trial, a randomized, double-blind, placebo-controlled trial of daily rosuvastatin 20 mg in a primary prevention population with LDL-C < 130 mg/dL, and high-sensitivity C-reactive protein (hsCRP) ≥ 2 mg/L. In total, 6780 out of 7272 men (93%) and 3604 out of 4097 women (88%) had hsTnI concentrations that were at or above the established limit of detection of 1.9 ng/L. In Cox proportional hazards models adjusted for typical cardiovascular risk factors and hsCRP, each 1-SD increment in ln(hsTnI) was associated with a 12% increase in the risk of the primary endpoint (HR 1.12, 95% CI 1.03-1.21; P<0.01), a composite of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, and cardiovascular death. The risk of the primary endpoint for participants in the highest as compared to the lowest tertile of hsTnI was 2.12 (95% CI, 1.43-3.14, P=0.0002; Table) and was similar in placebo (2.24, 95% CI 1.37-3.66; P=0.001) and rosuvastatin (1.86, 95% CI 0.96-3.59; P=0.06) treated patients. Rosuvastatin therapy was associated with a similar reduction in the adjusted risk of the primary endpoint for participants in the first (HR 0.56, 95% CI 0.29-1.13), second (HR 0.64 95% CI, 0.40-1.04) or third (HR 0.49, 95% CI 0.34-0.71) tertile of hsTnI (P=0.58 for hsTnI-rosuvastatin interaction).
Conclusions: In a primary prevention population baseline cardiac troponin I was associated with an increased risk of adverse cardiovascular events. We observed similar reductions in the relative risk of cardiovascular events with rosuvastatin therapy across all baseline concentrations of cardiac troponin. (NCT 00239681)
- © 2013 by American Heart Association, Inc.