Separating the contenders from the pretenders: competitive high-throughput biomarker screening in large population-based studies.

Despite great enthusiasm for biomarkers as tools to enhance risk prediction and to lead the way in a transformation towards personalized cardiovascular medicine, progress in the biomarker field has been painstakingly slow, particularly in the area of population screening. Some individual biomarkers such as C-reactive protein (CRP) have demonstrated consistent associations with incident cardiovascular events across multiple studies, but the magnitude of these associations is modest,1 and only small improvements in discrimination and reclassification are seen.2,3 One attractive solution to the limitations of individual biomarkers is to combine nonredundant biomarkers into panels to enhance risk assessment. However, results of studies testing multiple biomarkers for risk prediction in primary prevention populations have not provided a clear picture, with some studies showing qualified promise4–6 and others suggesting limited value.2,7,8