High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease

Abstract Background Cardiac troponinis 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 testingin the prevention of coronary heart disease has yet to be established. Objectives This study sought to determine whether troponinconcentration 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 pravastatin40 mg once daily or placebo for 5 years. Plasma cardiac troponin Iconcentration was measured with a high-sensitivity assay at baseline and at 1 year in 3,318 participants. Results Baseline troponinwas 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 Conclusions Troponinconcentration predicts coronary events, is reduced by statin therapy, and change at 1 year is associated with future coronary risk independent of cholesterol lowering. Serial troponinmeasurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions.