Biomarkers and cardiovascular risk assessment for primary prevention: an update

Lauren G Gilstrap, Thomas J Wang, Lauren G Gilstrap, Thomas J Wang

Abstract

Background: Interest in cardiovascular biomarkers in primary prevention has increased dramatically in the past decade. This increase has been fueled by an improved understanding of cardiovascular pathophysiology, as well as novel technologies for biomarker identification.

Content: In this review we provide a brief overview of recent concepts in the evaluation of screening biomarkers, because biomarkers may behave differently when used for screening as opposed to diagnosis or disease staging. The following specific biomarker examples are then discussed, with a focus on data from primary prevention studies: high-sensitivity C-reactive protein, B-type natriuretic peptide, lipoprotein-associated phospholipase A2, and high-sensitivity troponin T. The article concludes by addressing novel platforms for biomarker discovery, reviewing recent examples from the field of metabolomics.

Summary: An ongoing challenge is to develop screening strategies that can identify individuals at risk for cardiovascular events well before symptoms appear. For this purpose, the measurement of soluble biomarkers could be an important adjunct to traditional cardiovascular risk assessment. Recent studies highlight both the strengths and limitations of "novel" circulating biomarkers, and suggest that substantial work is still needed to identify biomarkers that are sufficiently accurate and cost-effective for routine use in primary prevention.

Figures

Figure 1
Figure 1
Relative risks for cardiovascular disease in individuals in the top vs bottom third of baseline BNP or NT-proBNP concentration, according to different study characteristics. From Di Angelantonio et al. Circulation. 2009;120:2177-87 (permission pending).
Figure 2
Figure 2
Association of troponin T detected with a highly sensitive assay and mortality risk. From deLemos, et al. JAMA 2010;304:2503-2512 (permission pending).
Figure 3
Figure 3
Biomarker identification and the genome, transcriptome, proteome, and metabolome. The numbers in the parentheses denote the estimated number of entities of each type of molecule. From Gerszten and Wang, Nature 2008;451:949-52 (permission pending).

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