https://orcid.org/0000-0001-5577-081X
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Rocco Vergallo, Carlo Patrono, Weekly Journal Scan: incremental utility of circulating biomarkers for cardiovascular risk prediction, European Heart Journal, Volume 45, Issue 40, 21 October 2024, Pages 4256–4258, https://doi.org/10.1093/eurheartj/ehae481
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Comment on ‘Prognostic Value of Cardiovascular Biomarkers in the Population’ which was published in JAMA, https://doi.org/10.1001/jama.2024.5596.
Comment
The foundation of preventive cardiology relies on the assessment of CVD risk using scores based on traditional risk factors.1 Several models and algorithms for CVD risk assessment have been developed and updated, including predictive models from the Framingham Heart Study,2 Pooled Cohort Equations recommended by the American Heart Association/American College of Cardiology guidelines,3 and the European Society of Cardiology SCORE2.4 Lifestyle interventions are generally recommended for individuals at low risk, while both lifestyle and pharmacologic therapies are typically recommended for those at highest risk.5 Additional ‘risk-enhancing’ factors, such as circulating biomarkers and/or imaging findings, can be used to reclassify CVD risk, especially in individuals at borderline or intermediate risk, providing opportunities for optimization of primary prevention strategies.5 Circulating cardiac biomarkers, including cardiac troponins, inflammatory biomarkers, or natriuretic peptides, are universally used in everyday clinical practice for the diagnosis of acute CVD. However, their circulating concentrations may also reflect subclinical heart and vascular damage, as suggested by a correlation of circulating levels of cardiac troponins and natriuretic peptides with the degree of atherosclerosis, ventricular hypertrophy, and vascular stiffness in the general population.6,7 Similarly, high-sensitivity C-reactive protein concentrations have been associated with the presence and degree of heart and vascular inflammation.8 Substantial evidence suggests that these biomarkers may thus contribute to primary CVD risk stratification in the general population.9 Prior analyses, however, were limited by small sample size, the use of aggregate data only, and/or short follow-up.
