General cardiology

Novel biomarkers add little to conventional risk factors

Recently, several novel biomarkers (eg, C-reactive protein (CRP), cystatin C, B-type natriuretic peptide (BNP)) have been proposed to aid in risk stratification for cardiovascular disease. However, debate still continues as to the utility of such biomarkers; for example, although the JUPITER study suggested that CRP could be used to identify high-risk individuals who would benefit from statin treatment, other studies have challenged whether there is any causal effect of CRP levels on cardiovascular disease (eg, Elliot et al, JAMA 2009;302:37–48).

Melander et al investigated the utility of a variety of novel biomarkers for the prediction of cardiovascular risk when compared with conventional risk factors. Importantly, they chose a low-to-intermediate risk population to study (the groups for whom current data are most conflicting) and furthermore their final analysis used a “multimarker” score (the sum of the several marker values measured) in addition to looking at individual predictors. The main outcome was incident cardiovascular and coronary events.

A total of 5607 patients (mean age 58 years; 60% women) without cardiovascular disease underwent baseline examination between 1991 and 1994 and were then followed up until 2006. During a median follow-up of 12.8 years, there were 418 cardiovascular and 230 coronary events. The incremental ability of the novel biomarkers, both individually and in combination, was small (table 1). However, the best combination of biomarkers for predicting cardiovascular events was CRP and N-BNP.

Currently, the use of novel biomarkers for primary cardiovascular …