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The Potential Role of Biomarkers Associated with ASCVD Risk: Risk-Enhancing Biomarkers
1Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Korea.
Insights
Serum cholesterol is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Non-traditional biomarkers like hsCRP and Lp(a) aid risk assessment in intermediate-risk patients, complementing traditional factors for better ASCVD prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Serum cholesterol is a primary risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Lowering low-density lipoprotein cholesterol (LDL-C) significantly reduces ASCVD events, particularly in high-risk individuals.
- Risk assessment in low-to-intermediate risk patients without ASCVD often relies solely on traditional factors, necessitating complementary approaches.
Purpose of the Study:
- To review the roles of non-traditional biomarkers in ASCVD risk assessment.
- To evaluate the utility of ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP), lipoprotein(a) (Lp[a]), and apolipoprotein B (apoB) as risk-enhancing factors.
- To align with the 2018 ACC/AHA guidelines for cholesterol management.
Main Methods:
- Literature review of current roles of specific non-traditional biomarkers.
- Analysis of biomarker integration into risk assessment strategies.
- Comparison of international guidelines regarding biomarker utilization.
Main Results:
- Non-traditional biomarkers (ABI, hsCRP, Lp(a), apoB) offer additive value in risk stratification beyond traditional factors.
- Coronary artery calcium (CAC) score is recognized for guiding statin therapy in specific intermediate-risk groups.
- The 2018 ACC/AHA guidelines incorporate these biomarkers as risk-enhancers, unlike some national guidelines.
Conclusions:
- Non-traditional biomarkers are crucial for comprehensive ASCVD risk assessment in intermediate-risk populations.
- Individualized risk modulation and management can be improved by incorporating these factors.
- Further research and guideline integration are needed for optimal utilization of these biomarkers in clinical practice.
Abstract:
Serum cholesterol is major risk factor and contributor to atherosclerotic cardiovascular disease (ASCVD). Therapeutic cholesterol-lowering drugs, especially statin, revealed that reduction in low-density lipoprotein cholesterol (LDL-C) produces marked reduction of ASCVD events. In the preventive scope, lower LDL-C is generally accepted as better in proven ASCVD patients and high-risk patient groups. However, in patients with low to intermediate risk without ASCVD, risk assessment is clinically guided by traditional major risk factors. In this group, the complement approach to detailed risk assessment about traditional major risk factors is needed. These non-traditional risk factors include ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, lipoprotein(a) (Lp[a]), apolipoprotein B (apoB), or coronary artery calcium (CAC) score. CAC measurements have an additive role in the decision to use statin therapy in non-diabetic patients 40-75 years old with intermediate risk in primary prevention. This review comprises ASCVD lipid/biomarkers other than CAC. The 2013 and 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines suggest these factors as risk-enhancing factors to help health care providers better determine individualized risk and treatment options especially regarding abnormal biomarkers. The recent 2018 Korean guidelines for management of dyslipidemia did not include these biomarkers in clinical decision making. The current review describes the current roles of hsCRP, ABI, LP(a), and apoB in personal modulation and management of health based on the 2018 ACC/AHA guideline on the management of blood cholesterol.
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