New Test Could Predict Risk of Recurrent Cardiovascular Events

A high sensitivity cardiac troponin I test may determine if vorapaxar treatment would effectively prevent recurrent heart attacks.

A new test may be able to identify patients with a high risk of recurrent heart attack or death resulting from cardiovascular disease. This test may also be able to identify patients who could benefit from treatment with vorapaxar.

Cardiovascular disease is responsible for hundreds of thousands of heart attacks per year, with 210,000 of those patients experiencing a recurrent heart attack, which causes significant patient harm and increased healthcare costs.

Preventing recurrent heart attacks is key. The first-line treatment for preventing recurrent cardiovascular events is antiplatelet drugs, such as vorapaxar. These drugs prevent clots from forming and growing in the arteries, which prevents cardiovascular events.

Vorapaxar is a new, potent drug that has been developed to improve standard treatments, such as aspirin. Although vorapaxar has significant antiplatelet effects, clinical trials have indicated that patients may experience serious bleeding side effects.

In a new study published by Clinical Chemistry, investigators found that a high sensitivity cardiac troponin I (hs-cTnI) test can determine which patients would benefit from vorapaxar drug therapy. This could reduce the amount of patients who take the drug without benefit and experience serious bleeding side effects.

The researchers measured hs-cTnI in 15,833 patients from a clinical trial of the drug who had experienced a previous heart attack, stroke, or peripheral arterial disease.

Patients with a hs-cTnI concentration of >26 ng/L had an 18.6% 3-year rate of mortality, heart attack, or stroke, compared with only 5% in patients with levels <1.9 ng/L, according to the study.

The investigators also found that treatment with vorapaxar reduced the risk of recurrent cardiovascular events by 1.86% in high-risk patients. In low-risk patients, initiation of vorapaxar reduced this risk by only 0.25%.

Of the patients included, 7.3% were considered high-risk, and benefited from vorapaxar.

While the drug is indicated for use in all patients who have experienced a heart attack, it may be especially effective if treatment is limited to patients with elevated hs-cTnL test results, according to the study.

More targeted use of the drug could improve patient outcomes by mitigating serious side effects in patients whose vorapaxar use is deemed unnecessary. It could also lead to lower healthcare costs for the patient and the healthcare industry by reducing unnecessary drug costs, and adverse event-related care and hospitalization.

"This study quantifies the magnitude of benefit with more potent antithrombotic secondary preventive therapy in patients with increased [hs-cTnI]," said lead researcher David A. Morrow, MD. "This finding is of particular relevance for novel therapies such as vorapaxar for which the decision to implement additional therapy balances the potential absolute gains versus risk of bleeding, and cost."