Cardiovascular biomarkers: added value with an integrated approach?

In primary prevention, traditional risk factors are a useful first step in the determination of who could be at risk for cardiovascular events. In the era of “global risk assessment” scores such as the Framingham score, the Prospective Cardiovascular Münster (PROCAM) score, or the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE), which are derived from multivariable statistical models, should be used.1 However, it has been noted that a considerable number of at-risk patients cannot be identified on the basis of traditional risk factors alone.2 This has prompted the search for novel markers of cardiovascular risk to help improve risk prediction.3 Such markers could either represent various blood biomarkers relevant to the pathophysiology of atherothrombosis (eg, markers of the inflammatory response, coagulation markers, markers of platelet aggregation, lipoproteins, or lipid-related variables), genetic markers, or markers of subclinical disease, which may also aid in improved risk prediction. Determination of global risk on the basis of traditional risk factors allows categorization into high (10-year risk, 20%), low (10-year risk, 10%), or intermediate risk (10-year risk, 10% to 20%). Subjects at high risk should be recommended lifestyle changes or prescribed a statin. Subjects at low risk would be reevaluated 3 to 5 years later. Those at intermediate risk, however, who comprise up to 40% of the population at risk,4 would be candidates for additional testing to increase or decrease their actual risk. A large panel of blood biomarkers are available for this purpose, but most of them are not yet applicable in clinical practice for various reasons5,6