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Progress towards identifying biomarkers of vascular aging for total cardiovascular risk prediction
1Peripheral Vessels Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. cvlachop@otenet.gr
Insights
Vascular aging biomarkers, like arterial stiffness, show promise for predicting cardiovascular risk beyond traditional factors. Arterial stiffness meets clinical criteria, while endothelial function has limitations for risk prediction.
Area of Science:
- Cardiovascular Medicine
- Biomarker Research
- Vascular Biology
Background:
- Traditional cardiovascular risk scores have limitations in predicting actual events.
- Vascular aging, reflecting cumulative risk factor impact on arteries, offers a potential measure of overall cardiovascular risk.
- Integrating new biomarkers requires validation for calibration, discrimination, and reclassification.
Purpose of the Study:
- To evaluate candidate arterial biomarkers for their potential to gauge cardiovascular risk.
- To assess if arterial biomarkers provide incremental predictive value over traditional risk factors.
- To determine which arterial biomarkers meet stringent criteria for clinical practice integration.
Main Methods:
- Review of current evidence on arterial stiffness, central hemodynamics, carotid intima-media thickness, and endothelial function.
- Assessment of biomarkers against criteria for calibration, discrimination, and reclassification.
- Comparison of predictive value against established cardiovascular risk factors.
Main Results:
- Arterial stiffness demonstrates fulfillment of criteria for a vascular aging biomarker.
- Central hemodynamics and carotid intima-media thickness are considered close contenders.
- Endothelial function exhibits methodological limitations impacting its risk prediction utility.
Conclusions:
- Arterial stiffness is a validated biomarker for vascular aging and cardiovascular risk assessment.
- Central hemodynamics and carotid intima-media thickness warrant further investigation for clinical application.
- Endothelial function, due to methodological variability, is less suitable for routine cardiovascular risk prediction.
Abstract:
Although several scoring systems for cardiovascular risk prediction are valuable in the assessment and management of asymptomatic individuals and patients, differences between predicted and actual events do exist. The concept of vascular aging as a cumulative measure of the impact of cardiovascular risk factors on the arterial wall has the potential to gauge an individual's overall cardiovascular risk. In this context, candidate arterial biomarkers, apart from proving an incremental predictive value over and above traditional risk factors, must fulfill stringent criteria in order to be integrated into clinical practice; these include calibration, discrimination and reclassification. Current evidence suggests that arterial stiffness fulfills the criteria for a biomarker of vascular aging, whereas central hemodynamics and carotid intima-media thickness are close. Endothelial function, although a valuable research tool, has shortcomings in terms of risk prediction, largely dependent on the methodological approach, which may make it less desirable as a biomarker.
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