title: High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease.
abstract: BACKGROUND
  Cardiac troponin is an independent predictor of cardiovascular mortality in individuals without symptoms or signs of cardiovascular disease. The mechanisms for this association are uncertain, and a role for troponin testing in the prevention of coronary heart disease has yet to be established.
  
  
  OBJECTIVE
  This study sought to determine whether troponin concentration could predict coronary events, be modified by statins, and reflect response to therapy in a primary prevention population.
  
  
  METHODS
  WOSCOPS (West of Scotland Coronary Prevention Study) randomized men with raised low-density lipoprotein cholesterol and no history of myocardial infarction to pravastatin 40 mg once daily or placebo for 5 years. Plasma cardiac troponin I concentration was measured with a high-sensitivity assay at baseline and at 1 year in 3,318 participants.
  
  
  RESULTS
  Baseline troponin was an independent predictor of myocardial infarction or death from coronary heart disease (hazard ratio [HR]: 2.3; 95% confidence interval [CI]: 1.4 to 3.7) for the highest (≥5.2 ng/l) versus lowest (≤3.1 ng/l) quarter of troponin (p < 0.001). There was a 5-fold greater reduction in coronary events when troponin concentrations decreased by more than a quarter, rather than increased by more than a quarter, for both placebo (HR: 0.29; 95% CI: 0.12 to 0.72 vs. HR: 1.95; 95% CI: 1.09 to 3.49; p < 0.001 for trend) and pravastatin (HR: 0.23; 95% CI: 0.10 to 0.53 vs. HR: 1.08; 95% CI: 0.53 to 2.21; p < 0.001 for trend). Pravastatin reduced troponin concentration by 13% (10% to 15%; placebo adjusted, p < 0.001) and doubled the number of men whose troponin fell more than a quarter (p < 0.001), which identified them as having the lowest risk for future coronary events (1.4% over 5 years).
  
  
  CONCLUSIONS
  Troponin concentration predicts coronary events, is reduced by statin therapy, and change at 1 year is associated with future coronary risk independent of cholesterol lowering. Serial troponin measurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions.
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Anoop S V
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ruiqi
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: McAllister
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Strachan
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Muriel
authors.initials: M
authors.lastname: Caslake
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Packard
authors.affiliation: BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: nick.mills@ed.ac.uk.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Mills
mesh_terms: D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D004562:Electrocardiography / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D019210:Troponin I / Q000097:blood*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019210:Troponin I
keywords: cardiac troponin; cardiovascular risk; primary prevention; statins