State of the Art: Blood Biomarkers for Risk Stratification in Patients with Stable Ischemic Heart Disease

Abstract

BACKGROUND:Multiple circulating biomarkers have been associated with the incidence of cardiovascular events and proposed as potential tools for risk stratification in stable ischemic heart disease (IHD), yet current guidelines do not make any firm recommendations concerning the use of biomarkers for risk stratification in this setting. This state-of-the-art review provides an overview of biomarkers for risk stratification in stable IHD.CONTENT: Circulating biomarkers associated with the risk of cardiovascular events in patients with stable IHD reflect different pathophysiological processes, including myocardial injury, myocardial stress and remodeling, metabolic status, vascular inflammation, and oxidative stress. Compared to the primary prevention setting, biomarkers reflecting end-organ damage and future risk of heart failure development and cardiovascular death may play more important roles in the stable IHD setting. Accordingly, biomarkers that reflect chronic, low-grade myocardial injury, and stress, i.e., high-sensitivity cardiac troponins and natriuretic peptides, provide graded and incremental prognostic information to conventional risk markers. In contrast, in stable IHD patients the prognostic value of traditional metabolic biomarkers, including serum lipids, is limited. Among several novel biomarkers, growth-differentiation factor-15 may provide the most robust prognostic information, whereas most inflammatory markers provide limited incremental prognostic information to risk factor models that include conventional risk factors, natriuretic peptides, and high-sensitivity troponins.

Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study

“…Despite signi cant advances in the diagnosis and therapy of cardiovascular disease (CVD), patients with established coronary artery disease (CAD) are generally at higher risk of developing recurrent cardiovascular events (CVEs) than the primary prevention individuals [1]. Clinical trials revealed that in the short time window only 20% to 30% of patients bene t even if traditional risk factors were well managed [2,3].…”

Promising utilities of growth differentiation factor 15 in cardiovascular diseases

“…Cardiovascular (CV) diseases are the leading causes of mortality and disability in general population worldwide [1]. Contemporary decision-making of both prevention and treatment of CV diseases bases on risk stratification and enroll the appropriate patients for further procedures and medical care [2,3]. Because there is considerable heterogeneity in CV risk assessment with clinical tools and even when one more CV risk score systems are used, the exact CV risk determination might be facilitated by an implementation of individual CV risk stratification with biomarkers reflected numerous various faces of pathogenesis of the disease [4].…”

Prognostic utility of lipoprotein(a) combined with fibrinogen in patients with stable coronary artery disease: a prospective, large cohort study

“…Background Despite significant advances in the diagnosis and therapy of cardiovascular disease (CVD), patients with established coronary artery disease (CAD) are generally at higher risk of developing recurrent cardiovascular events (CVEs) than the primary prevention individuals [1]. Clinical trials revealed that in the short time window only 20-30% of patients benefit even if traditional risk factors were well managed [2,3].…”