Serial troponin measurements could predict cardiovascular risk
medwireNews: Cardiac troponin I levels are reduced by statin therapy, and troponin reductions over a year are associated with better future outcomes regardless of cholesterol lowering, study results suggest.
“Serial troponin measurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions,” say lead investigator Nicholas Mills (University of Edinburgh, UK) and co-authors.
The researchers analyzed data from 3318 participants of the WOSCOPS (West of Scotland Coronary Prevention Study) trial, in which men with raised low-density lipoprotein (LDL) cholesterol and no history of myocardial infarction were randomly assigned to receive pravastatin or placebo.
They found that participants with the highest quartile of plasma troponin concentration (≥5.2 ng/L) at baseline had a significantly higher risk for nonfatal myocardial infarction or death from coronary heart disease (CHD) at 5 and 15 years than those in the lowest quartile (≤3.1 ng/L), with hazard ratios (HRs) of 2.27 and 1.54, respectively.
Furthermore, men receiving pravastatin experienced a 19% reduction in troponin levels at 1 year, compared with a 6% reduction among participants receiving placebo.
And when participants were divided into five groups based on changes in troponin levels in the placebo group, treatment with pravastatin compared with placebo doubled the number of men whose troponin levels fell by more than a quarter (645 vs 320).
Taking pravastatin conferred around a three-quarters reduction in the risk for coronary events among men in the group with the largest decreases in troponin levels, but had no effect among those with the smallest troponin decreases, despite the groups achieving “similar reductions” in LDL cholesterol levels.
Pravastain “increased the propensity for troponin concentrations to fall, leading to additive decrements in future risk that appeared to be independent of LDL cholesterol lowering,” explain the study authors in the Journal of the American College of Cardiology.
They note that a biomarker that can “dynamically track” the risk for CHD over time would be “a major step forward,” and “serial high-sensitivity troponin measurements could represent a major surrogate biomarker to help manage our patients.”
The authors of an accompanying editorial comment, Allan Jaffe and R Scott Wright (both from Mayo Clinic, Rochester, Minnesota, USA) agree that the study results “suggest a potential role for [high-sensitivity cardiac troponin] values as a measurement of whether primary prevention strategies are working.”
They caution that the troponin measurements at baseline “are too low and overlap too substantially with normal values to be used to determine risk in individual patients,” but believe that “serial values may be able to identify those who are ‘statin responders’ or at least to define those at lower and higher risk.”
And the commentators conclude: “In the long run, it should be possible to determine how to deploy [high-sensitivity cardiac troponin] analysis to allow values to be clinically relevant, including helping to assess those who may benefit from statin therapy.”
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