Biomarkers for Cardiovascular Screening: Progress or Passé?

[摘要] This special issue of Clinical Chemistry includes multiple important studies on clinical and analytic aspects of established and emerging biomarkers for cardiovascular disease. Several biomarkers featured in these pages—cardiac troponin and measures of natriuretic peptides, as well as validated biomarkers such as high-sensitivity C-reactive protein (hsCRP)2 and coronary calcium scores—can improve the performance of risk prediction algorithms based solely on more traditional cardiovascular risk factors. Yet while patients and providers are interested in ever more “personalized” recommendations for risk prevention, the major guidelines from the American College of Cardiology, American Heart Association, European Society of Cardiology, and US Preventive Services Task Force remain focused on absolute risk based on epidemiologic modeling to determine when to give preventive treatments such as aspirin and statin therapy. Thus, considerable tension exists between traditional epidemiologic approaches to risk prediction for the “average patient” and the biologic reality that different pathophysiologic processes are highly relevant for the individual patients seen in daily practice.The biomarkers with the broadest application in cardiovascular medicine are cholesterol and blood pressure. These markers predict cardiovascular risk, identify patients for whom a particular therapy has benefit, and serve as treatment targets. As “factors of risk” for coronary heart disease, blood pressure and cholesterol are nearly as old as the specialty of cardiovascular medicine and were described by Dr. William B. Kannel and colleagues in their seminal publication from the Framingham Heart Study in 1961 (1). In the ensuing 55 years, there has been a steady year-over-year increase in the publications indexed with “cardiovascular biomarkers” in PubMed, both as an absolute number of publications (Figure 1A) and a proportion of all “cardiovascular” publications indexed (Figure 1B). And yet, despite the predictive accuracy or prognostic value of many of these biomarkers, none was found to offer sufficient new information …

[学科分类] 过敏症与临床免疫学