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

Figures

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  Figure 1. Cumulative Incidence Plot for Primary Outcome of Nonfatal Myocardial Infarction or Death From Coronary Heart Disease, and Secondary Outcomes of Cardiovascular and Noncardiovascular Death Stratified by Quarter of Troponin at Baseline Higher troponin concentrations at baseline were associated with increased risk of coronary heart disease (CHD) at both 5- and 15-year follow-up. Compared to the lowest quarter (≤3.1 ng/l), patients in the highest quarter (≥5.2 ng/l) were at the highest risk for nonfatal myocardial infarction or death from CHD at 5 and 15 years (hazard ratio: 2.27; 95% confidence interval: 1.42 to 3.65; and hazard ratio: 1.54; 95% confidence interval: 1.16 to 2.05, respectively; p < 0.001 for both). Cardiovascular death was also associated with baseline troponin concentration (p < 0.001), but noncardiovascular death was not (p = 0.890).

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  Figure 2. Percent Change in High-Sensitivity Cardiac Troponin I and LDL Cholesterol Concentrations at 1 Year in Placebo and Pravastatin Groups Line of fit is a Pearson correlation (pravastatin group r = 0.20; p < 0.001). The ellipses are prediction ellipses with 95% confidence interval under the assumption the samples are bivariate normal to display linear correlation. LDL = low-density lipoprotein.

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  Figure 3. Change in Troponin Concentration at 1 Year Stratified by Treatment Allocation and Nonfatal Myocardial Infarction or Coronary Heart Disease Death at 5 Years (Top) Nonfatal myocardial infarction or death from coronary heart disease (CHD) at 5 years in those taking pravastatin (orange) and placebo (blue) stratified into fifths by change in troponin concentration in the placebo group: Q1 = >26% increase; Q2 = 2% to 25% increase; Q3 = 2% increase to 13% decrease; Q4 = 13% to 27% decrease; Q5 = ≥27% decrease. (Middle) Twice as many participants were in the lowest-risk group (Q5), with >27% reductions in troponin concentration (645 vs. 320 on placebo; p < 0.001), and 30% fewer were in the highest-risk group (Q1) with >26% increase in troponin concentration (223 vs. 320 on placebo; p < 0.001). (Bottom) Using participants in the placebo group whose troponin concentrations were unchanged as a referent (Q3), hazard ratios for the primary outcome were determined for each fifth after adjustment for age, body mass index, heart rate, systolic blood pressure, diastolic blood pressure, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol, symptoms of angina, diabetes,…

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  Central Illustration. Novel Applications of Cardiac Troponins: Stratifying Risk and Guiding Therapy for Prevention of Cardiovascular Disease LDL = low-density lipoprotein.