Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence

Area of Science:

• Cardiovascular Medicine
• Epidemiology
• Biochemistry

Background:

• Atherosclerotic vascular disease presents a significant global health challenge.
• Emerging risk factors are being investigated to improve identification of high-risk individuals.

Purpose of the Study:

• To review evidence on four emerging risk factors: C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine.
• To assess their role in atherosclerotic vascular disease risk and potential screening applications.

Main Methods:

• A comprehensive literature search of MEDLINE and other sources was conducted from 1990 to 2003.
• Included studies encompassed epidemiological, basic science, and clinical trial data.
• 373 relevant studies were identified and analyzed.

Main Results:

• Epidemiological and basic science data indicate independent associations between the four factors and atherosclerotic vascular disease.
• Limited data exist on the added value of screening these factors beyond current risk assessment strategies.
• Few intervention studies have targeted these specific factors for risk reduction.

Conclusions:

• C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine are linked to vascular disease risk.
• The optimal application of these markers in routine screening and risk stratification is not yet established.