Markers of Preclinical Atherosclerosis and their Clinical Relevance

Abstract

© 2015 Hans Huber Publishers, Hogrefe AG, Bern. The estimation of risk for atherosclerotic and cardiovascular events based only on the presence of classical risk factors is oft en insuffi cient. Th erefore, eff orts have been made to fi nd markers that indicate the presence of preclinical disease in individual subjects: blood markers of atherosclerosis and preclinical deterioration of the arterial wall. Elevated levels of several infl ammatory mediators have been found in subjects with atherosclerosis. Increased basal levels of cytokines, the cell adhesion molecules, selectins and acute-phase reactants such as high sensitive C-reactive protein (hsCRP), fi brinogen, and serum amyloid A are related to an increased risk of cardiovascular events. For clinical purposes, the most promising infl ammatory biomarker appears to be hsCRP. In the last decade, markers of plaque stability and unstable coronary artery disease have been sought. Further, markers of endothelial dysfunction, like circulating molecules as well as indicators of functional deterioration of the arterial wall were identifi ed. It was shown that endothelial dysfunction is closely related to diff erent risk factors of atherosclerosis, and to their intensity and duration. Intima-media thickness measurement has emerged as one of the methods of choice for determining the anatomic extent of preclinical atherosclerosis and for assessing cardiovascular risk.Determination of markers of preclinical atherosclerosis improve individual risk determination and could infl uence the decision of a clinician to intervene with medication and to use more aggressive treatment of risk factors in high risk subjects and in patients with atherosclerotic disease.