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Vulnerable plaque versus vulnerable patient: emerging blood biomarkers for risk stratification
J A Páramo1, J A Rodríguez, J Orbe
1Atherosclerosis Research, Division of Cardiovascular Sciences, CIMA, University of Navarra, Pamplona, Avda Pio XII 55 31008 Pamplona, Spain. japaramo@unav.es
Insights
Biomarkers, such as C-reactive protein (CRP), can help predict cardiovascular event risk. A multimarker approach may offer superior cardiovascular risk assessment compared to single markers.
Area of Science:
- Biochemistry
- Cardiology
- Molecular Biology
Background:
- Biomarkers are crucial for diagnosing and predicting disease, reflecting underlying pathological processes.
- For coronary heart disease, biomarkers must represent the vascular wall's biology, particularly atherosclerosis.
- Clinical utility hinges on accuracy, reliability, sensitivity, specificity, and widespread applicability.
Purpose of the Study:
- To evaluate the potential clinical utility of various biomarkers for cardiovascular disease risk prediction.
- To investigate the role of C-reactive protein (CRP) and its interaction with matrix metalloproteinases (MMPs).
- To assess the value of inflammatory markers in refining cardiovascular risk prediction.
Main Methods:
- Accumulation of data on markers of inflammation, hemostasis, thrombosis, phospholipases, proteolysis, and oxidative stress.
- Specific investigation into C-reactive protein (CRP) and its effect on endothelial metalloproteinases (MMPs).
- Evaluation of the potential of circulating inflammatory markers to improve risk prediction models.
Main Results:
- C-reactive protein (CRP) is identified as a potential biomarker for primary prevention.
- CRP was found to enhance the endothelial expression of matrix metalloproteinases (MMPs).
- Circulating inflammatory markers show potential for refining cardiovascular event risk prediction.
Conclusions:
- While inflammatory markers like CRP show promise in refining cardiovascular risk prediction, their addition to current scores requires careful evaluation of benefits and costs.
- A multimarker strategy, combining inflammatory and non-invasive risk markers, may be more effective than single-marker assessment for cardiovascular risk estimation.
Abstract:
Biomarkers are generally considered to be plasma measurements of molecules, proteins, or enzymes that provide independent diagnostic and prognostic value by reflecting an underlying disease state or condition. In the case of coronary heart disease, they must reflect the underlying biology of the vessel wall and in particular, the atherosclerotic process and/or its sequelae. The clinical utility of a biomarker depends on its ability to account for a significant proportion of the disease being evaluated; it should be accurate and reliable; provide good sensitivity and specificity; and be available for widespread application. Data are being accumulated on the potential clinical utility of markers of inflammation, hemostasis and thrombosis, phospholipases, proteolysis and oxidative stress. Whereas C-reactive protein (CRP) emerges as a biomarker in the setting of primary prevention, we have recently found that CRP enhances the endothelial expression of metalloproteinases (MMPs). Regardless of the causality, circulating inflammatory markers have the potential to refine prediction of risk of cardiovascular events. However, a recommendation that they should be added to current risk factor scores is premature, since the benefits and costs of screening with any inflammatory marker require careful evaluation. A multimarker approach to estimate cardiovascular risk either by inflammatory markers and cumulative risk markers obtained from non-invasive tests or both may be superior to assessing a single marker.
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