Cardiovascular Risk Prediction

Abstract

International guidelines recommend cardiovascular risk assessment by integrating classical risk factors such as blood pressure or LDL cholesterol by algorithms or scores. This strategy has a very good negative predictive value: Depending on the specific guideline, 50 % to 75 % of middle aged males and 90 % of females in Germany fall into this low risk category and will not need any intervention with lipid or blood pressure lowering drugs. In 7 to 20 % of middle-aged males cardiovascular risk is estimated to be high or very high so that intensive risk factor intervention is recommended. However, even if not treated, less than one third of these high-risk men will experience a cardiovascular event. Additional biomarkers are thus needed to improve the positive predictive value of conventional biomarkers and hence also to better personalize the indication and optimize cost-benefit of risk factor interventions. This need is even higher in patients with intermediate risk (about 15 to 30 % of middle-aged men and 10 % of middle-aged women) in whom the problem of undertreatment is most severe. As yet there is no biochemical or genetic biomarker available which improves risk prediction consistently and in a clinically relevant way, so that no international guideline currently recommends any of these emerging risk factors into clinical routine testing of cardiovascular risk. Of note, biomarkers that assess either the organ damage or dysfunction caused by atherosclerosis (troponins and B-type natriuretic peptides) were found to confer the best improvement of cardiovascular risk prediction by conventional markers. As the consequence functional genomics is applied to identify molecules that are released by plaques or thrombi into the blood stream and may hence be exploited for improved cardiovascular risk assessment but also monitoring of disease activity.