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Published on: January 28, 2020
Myocardial biomarkers for prediction of cardiovascular disease
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden. johan.sundstrom@medsci.uu.se
Insights
Identifying individuals at high risk for cardiovascular events is crucial for effective prevention. While established risk factors are reliable, new molecular biomarkers offer limited added value for prediction but significantly advance understanding of cardiovascular disease pathophysiology.
Area of Science:
- Cardiology
- Biomarker Discovery
- Preventive Medicine
Background:
- Accurate identification of individuals at high risk for future cardiovascular events is essential for targeted preventive strategies.
- Established risk factors are currently sufficient for reliable risk prediction in the general population, indicating a low unmet need for new predictive biomarkers.
- The clinical utility of new biomarkers for cardiovascular risk prediction requires demonstration of added discriminative capacity beyond existing risk factors.
Purpose of the Study:
- To evaluate the role and potential of novel molecular biomarkers in predicting cardiovascular events.
- To assess the added value of new biomarkers compared to established risk factors in cardiovascular risk prediction.
- To explore the utility of myocardial biomarkers in understanding the pathophysiology of cardiovascular disease.
Main Methods:
- Review of established cardiovascular risk factors and their predictive capabilities.
- Analysis of criteria for clinical adoption of new biomarkers, including statistical significance and added discriminative value.
- Examination of biomarkers originating from the myocardium, including cardiomyocytes and non-cardiomyocytes.
Main Results:
- Established risk factors provide reliable prediction of cardiovascular events, limiting the need for new predictive biomarkers in the general population.
- Troponin-I and N-terminal fragment of brain natriuretic peptide have demonstrated added discriminatory value in risk prediction.
- Numerous other myocardial biomarkers show promise for enhancing the understanding of cardiovascular disease pathophysiology, even if not adopted for risk prediction.
Conclusions:
- The clinical value of new biomarkers for cardiovascular event prediction is limited, as established factors are effective.
- New biomarkers hold significant potential for elucidating the pathophysiology of cardiovascular diseases.
- Further research into myocardial biomarkers can deepen our comprehension of cardiovascular disease mechanisms.
Abstract:
The identification of those persons in the population who have the highest risk of future cardiovascular events is important for targeting intensive preventive efforts. This can be reliably done using a handful of long since established risk factors. The unmet need for new molecular biomarkers for prediction of cardiovascular events in the general population is therefore low. In order for a new biomarker to be used clinically for risk prediction, a statistically significant association of levels of the biomarker to adverse outcome is not enough, but the biomarker should also be demonstrated to add discriminative capacity beyond established risk factors. In contrast to the limited value of new biomarkers for risk prediction, their usefulness for unraveling the pathophysiology of cardiovascular disease is large. The myocardium is the source of a vast number of interesting biomarkers, of which a few may be useful for risk prediction in the general population. Two of these, troponin-I and the N-terminal fragment of brain natriuretic peptide, have passed tests of added discriminatory value. Numerous other biomarkers produced by cardiomyocytes or non-cardiomyocytes in the myocardium are promising, and if they are not proven useful for risk prediction, they will unquestionably enhance our understanding of cardiovascular disease.
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