title: High-sensitivity cardiac troponin I and B-type natriuretic Peptide as predictors of vascular events in primary prevention: impact of statin therapy.
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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.
authors.affiliation: 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.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Everett
authors.affiliation: 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.).
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: 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.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: 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.).
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: 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.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000517:prevention & control; D015415:Biomarkers; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005464:Fluorobenzenes / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011322:Primary Prevention; D011446:Prospective Studies; D011743:Pyrimidines / Q000494:pharmacology / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use*; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; C518660:TNNT3 protein, human; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D000068718:Rosuvastatin Calcium
keywords: hydroxymethylglutaryl-CoA reductase inhibitors; natriuretic peptide, brain; primary prevention; troponin
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