Everett, BrendanZeller, TanjaGlynn, RobertRidker, PaulBlankenberg, Stefan2015-07-132015Everett, Brendan M., Tanja Zeller, Robert J. Glynn, Paul M Ridker, and Stefan Blankenberg. 2015. “High-Sensitivity Cardiac Troponin I and B-Type Natriuretic Peptide as Predictors of Vascular Events in Primary Prevention: Impact of Statin Therapy.” Circulation 131 (21): 1851-1860. doi:10.1161/CIRCULATIONAHA.114.014522. http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014522.0009-7322http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295540Background— 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. Methods and 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. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681.en-USEpidemiology and Preventionhydroxymethylglutaryl-CoA reductase inhibitorsnatriuretic peptide, brainprimary preventiontroponinJournal Article2015-07-1310.1161/CIRCULATIONAHA.114.014522