High Sensitivity Cardiac Troponin I and B-Type Natriuretic Peptide as Predictors of Vascular Events in Primary Prevention: Impact of Statin Therapy
Background—Cardiac troponin and B-type natriuretic peptide (BNP) concentrations associate 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 JUPITER (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin) trial before randomization to rosuvastatin 20 mg per day 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% CI 1.56-3.06; P-trend<0.001). BNP levels in the highest tertile were also associated a first cardiovascular event (aHR 1.94, 95% CI 1.41-2.68, P-trend<0.001). The risk of all-cause mortality was elevated for the highest vs. the lowest tertiles of hsTnI (aHR 2.61, 95% CI 1.81-3.78; P-trend<0.001) and BNP (aHR 1.45, 95% CI 1.03-2.04; P-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-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 Information—www.clinicaltrials.gov. Identifier: NCT 00239681.
- Received November 25, 2014.
- Revision received February 25, 2015.
- Accepted March 18, 2015.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.