New directions in cardiovascular risk assessment: the role of secondary risk stratification markers

Area of Science:

• Cardiology
• Preventive Medicine
• Biomarker Research

Background:

• Current cardiovascular disease (CVD) risk screening utilizes multivariate methods and calculators from epidemiological studies.
• These methods identify approximately 70% of individuals at risk for CVD events, necessitating improved predictive capacity.

Purpose of the Study:

• To evaluate the potential of incorporating additional risk factors and novel biomarkers into existing CVD risk screening protocols.
• To enhance the identification of individuals at risk for cardiovascular events.

Main Methods:

• Review of existing literature on established and emerging CVD risk factors.
• Assessment of evidence for adding family history, lipoprotein (a), C-reactive protein, N-terminal pro-B-type natriuretic peptide, coronary artery calcium score, carotid intima-media thickness, ankle-brachial index, and high-sensitivity troponins.
• Consideration of studies focusing on intermediate-risk groups and the general population.

Main Results:

• Family history of premature CVD is a well-established addition.
• Lipoprotein (a) and C-reactive protein show promise for specific populations and general use, respectively.
• N-terminal pro-B-type natriuretic peptide and coronary artery calcium score significantly enhance risk prediction.
• Data for carotid intima-media thickness and ankle-brachial index are less robust; high-sensitivity troponins show potential but require more data.

Conclusions:

• Additional biomarkers can improve CVD risk classification beyond conventional methods.
• Large-scale meta-analyses of pooled patient data are crucial to determine optimal additional markers and their application groups.
• Further research is needed to validate emerging markers for widespread CVD risk assessment.