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Cardiac Troponin I, BNP, and Vascular Events in Primary Prevention: Impact of Statin Therapy | Journal Scan
Study Questions:
Does statin therapy reduce cardiovascular events (CVEs) independent of the level of high-sensitivity cardiac troponin I (hs-TnI) and B-type natriuretic peptide (BNP) concentrations in primary prevention populations?
Methods:
Hs-TnI was measured in 12,956 and BNP in 11,076 participants without CV 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.
Results:
Nearly 92% of participants had detectable circulating hs-TnI, 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. Hs-TnI concentrations in the highest tertile were associated with a first major CVE (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 with a first CVE (aHR, 1.94; 95% CI, 1.41-2.68; P-trend < 0.001). The risk of all-cause mortality was elevated for the highest versus the lowest tertiles of hs-TnI (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 CVE across categories of hs-TnI (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 TnI 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 hs-TnI or BNP concentrations.
Perspective:
In the highest category of baseline hs-TnI, rosuvastatin therapy was associated with the most substantial reduction in the absolute risk of CVEs, and therefore, the lowest numbers needed to treat (NNT = 18), which is similar to a Framingham Risk Score of >10% (NNT = 20). In the JUPITER study, both hs-TnI and BNP provided independent prognostic information, as has been shown in other primary prevention studies. The value of hs-TnI and BNP for deciding treatment strategies for primary coronary artery disease prevention in general populations remains to be determined.
Keywords: Coronary Artery Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Natriuretic Peptide, Brain, Numbers Needed To Treat, Primary Prevention, Troponin I, Fluorobenzenes, Pyrimidines, Sulfonamides
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