Risk stratification in secondary prevention: advances in multimarker profiles, or back to basics?

Prevention and risk management of atherosclerotic vascular disease remain major health challenges. Coronary heart disease (CHD) and other cardiovascular diseases remain the primary causes of mortality and morbidity in developed countries. Improvement of risk stratification by identification of new biomarkers has been extensively investigated in both primary and secondary clinical settings in the past decade. A substantial number of biomarkers, representing various stages of atherogenesis and impaired cardiac function, have been evaluated against modifiable traditional risk factors, such as cholesterol, blood pressure, smoking status, and diabetes.1–4 However, whether these various biomarkers add incremental prognostic information to that provided by traditional risk factors is still controversial, and the clinical implications of “high” biomarker levels have yet to be determined. A multimarker strategy of combining biomarkers may theoretically help clinicians to stratify subjects into risk categories, but data on this subject are scarce.5,6