Future biomarkers in cardiology: My favourites

Abstract

Circulating biomarkers are key to risk assessment, diagnosis, prognosis, and disease management in cardiovascular disease (CVD). To attain "favourite" status new candidate markers must add accessible, reliable, and independent new information which contributes to improved clinical management. Currently the two best established markers in CV disease are the B type cardiac natriuretic peptides and cardiac troponin. These reflect myocyte load and injury and have established roles in the management of heart failure and acute coronary syndromes. We lack similarly well-proven markers for other pathophysiological pathways (including inflammation, oxidative stress and fibrosis) which are pivotal in cardiovascular disease. We also lack well-validated high performing markers of premorbid risk of CVD. A plethora of candidate markers are currently under assessment to fill these unmet needs including cytokines, peptides, proteins, metabolites, and circulating nucleic acids. As specific anti-inflammatory, anti-oxidant, and anti-fibrotic therapies become established in progressively earlier phases of CVD, we will require specific markers for case selection and assessment of efficacy.