Editorial: Emerging Biomarkers for the Optimal Assessment of Global Cardiovascular Risk: where do we Stand?

ABSTRACT

Atherosclerotic vascular disease remains an enormous public health problem [1]. The estimation of risk for cardiovascular events is traditionally based on factors such as age, sex, cholesterol, high density lipoprotein (HDL)-cholesterol, blood pressure levels, presence of diabetes mellitus, and cigarette smoking history. As our understanding of the vascular biology of atherosclerosis grows, the list of potential mediators and markers of the disease process increases. There is increasing evidence that these biomarkers may be sensitive, specific and reliable in identifying individuals at risk [2]. This supplemental issue of the Open Clinical Chemistry Journal focuses on recent advances in the assessment of cardiovascular risk with the implementation of newer risk factors such as inflammatory markers, newer lipid measurements, and factors associated with the oxidative stress, thrombosis and hemostasis [2]. Distinguished authors in the field were invited to give answers as to whether these novel risk factors should be incorporated into cardiovascular risk estimation. It is established that inflammatory processes play a fundamental role in the development of cardiovascular disease (CVD). Current evidence suggests that high sensitivity C-reactive protein (hsCRP) is a strong prognostic factor for CVD events. A direct involvement of CRP in the pathogenesis of atherosclerosis has also been implied. Nakou et al. review contemporary relevant literature and suggest that determination of hsCRP levels may be useful in therapeutic considerations help guiding medical treatment initiation and adjustment in certain groups of subjects both in the primary and secondary prevention. Serum total homocysteine (tHcy) has been implicated in promoting venous thromboembolic events and coronary, cerebral and peripheral artery atherosclerosis. In this respect, it was anticipated that dietary supplementation with B complex vitamins by lowering tHcy concentrations would result in risk reduction of CVD events. However, this was not shown in randomized controlled trials. Athyros et al. analyse recent evidence on the impact of tHcy on health status as well as the potential role of vitamin B supplementation. Hemostatic and thrombotic factors, such as fibrinogen, factor VII, von Willebrand factor, tissue plasminogen activator, plasminogen activator inhibitor - 1, and D-dimers, have been reported to be related with CVD. However, their contribution to the prediction of future CVD events on top of conventional risk factors remains to be established. Lioudaki and Ganotakis suggest that further investigation is required to clarify whether and which of these factors may claim a position in everyday clinical practice. Lipoprotein (a) [Lp(a)] is considered a strong and independent predictor of many forms of vascular disease. Evidence from cross-sectional and prospective studies is conflicting with regard to its role in the development of stroke. An important issue to be resolved concerns the methodology of Lp(a) measurement. Christogiannis et al. are in favour of an aggressive management of established CVD risk factors in subjects exhibiting elevated serum Lp(a) levels........