Ford Ian, Shah Anoop S V, Zhang Ruiqi, McAllister David A, Strachan Fiona E, Caslake Muriel, Newby David E, Packard Chris J, Mills Nicholas L
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom.
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
J Am Coll Cardiol. 2016 Dec 27;68(25):2719-2728. doi: 10.1016/j.jacc.2016.10.020.
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.
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.
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.
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).
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.
心肌肌钙蛋白是无心血管疾病症状或体征个体心血管死亡的独立预测因子。这种关联的机制尚不确定，肌钙蛋白检测在冠心病预防中的作用尚未确立。
本研究旨在确定肌钙蛋白浓度是否能预测冠心病事件、是否受他汀类药物影响，以及在一级预防人群中反映治疗反应。
WOSCOPS（苏格兰西部冠心病预防研究）将低密度脂蛋白胆固醇升高且无心肌梗死病史的男性随机分为两组，一组每天服用40mg普伐他汀，另一组服用安慰剂，为期5年。对3318名参与者在基线和1年时用高敏检测法测量血浆心肌肌钙蛋白I浓度。
对于肌钙蛋白最高（≥5.2ng/l）四分位数与最低（≤3.1ng/l）四分位数的人群，基线肌钙蛋白是心肌梗死或冠心病死亡的独立预测因子（风险比[HR]：2.3；95%置信区间[CI]：1.4至3.7）（p<0.001）。当肌钙蛋白浓度下降超过四分之一而非上升超过四分之一时，安慰剂组（HR：0.29；95%CI：0.12至0.72对比HR：1.95；95%CI：1.09至3.49；趋势p<0.001）和普伐他汀组（HR：0.23；95%CI：0.10至0.53对比HR：1.08；95%CI：0.53至2.21；趋势p<0.001）的冠心病事件减少幅度均高出5倍。普伐他汀使肌钙蛋白浓度降低了13%（10%至15%；经安慰剂校正，p<0.001），并使肌钙蛋白下降超过四分之一的男性人数增加了一倍（p<0.001），这表明他们未来发生冠心病事件的风险最低（5年内为1.4%）。
肌钙蛋白浓度可预测冠心病事件，他汀类治疗可降低其浓度，且1年时的变化与未来冠心病风险相关，独立于胆固醇降低情况。连续测量肌钙蛋白在评估心血管风险和监测治疗干预效果方面具有重大潜力。
