Integrating biomarkers: the new frontier?

Abstract

Risk stratification for cardiovascular diseases (CVD) remains suboptimal even after the introduction of global risk assessment by various scores. This has prompted the search for additional biomarkers which might help to improve risk stratification. Basically, there are blood biomarkers representing various pathophysiological pathways of atherosclerosis, markers of subclinical disease, and potentially genetic markers. Since inflammatory processes accompany all stages of atherosclerosis, measurement of plasma/serum concentrations of circulating inflammatory biomarkers has received great attention. Such biomarkers can be measured systemically by sensitive assays and elevated concentrations in the circulation have been shown to be associated with future CVD events. Thus, they might add to the predictive value of the atherogenic lipoprotein phenotype to further improve CVD risk assessment. In addition, several non-invasive imaging techniques are available for which also a predictive value for CVD could be established, in particular measurement of the intima-media thickness of the carotid artery using high resolution ultrasound and measurements of coronary calcium by coronary computed tomography. However, for most of these biomarkers the clinical utility has not yet been firmly established. This applies even more to an integrated approach combining blood biomarkers and markers of subclinical disease. Thus, more data, preferably from serial measurements in large populations taking also into account new candidates from "omics" technology are needed to gain further insight in the potential clinical usefulness of an integrated approach.