In this presentation Dr. Ridker talks about biomarkers and cardiovascular risk, and where high-sensitivity C-reactive protein (hsCRP) may play a role clinically.

Several biomarkers have been independently associated with the future risk of myocardial infarction and stroke. These include markers of inflammation, hemostasis and thrombosis, adipocyte function, and lipids. In terms of having prospective studies, a standardized assay, as well as additive value to lipid screening and the Framingham risk score, hsCRP is an interesting candidate for clinical use.

Some studies show evidence for improved cardiovascular risk stratification with hsCRP measurement. For example in a study reported by Cook et al. last year, it was concluded that "a global risk prediction model that includes hsCRP improves cardiovascular risk stratification in women, particularly among those with risk of 5% to 20%."(1)

Can hsCRP levels be used in targeting statin treatment? Back in 1998, data from the Cholesterol and Recurrent Events (CARE) trial showed that those patients who had evidence of inflammation had greater benefit from statin therapy compared to those without inflammation (2). The AFCAPS/TexCAPS trial further showed that subjects with below average LDL cholesterol (LDL-C) but above average C-reactive protein levels were also at increased risk of events, and received benefit from statin therapy (3). Of current interest is the large, randomized JUPITER trial which is underway, and looking at rosuvastatin in the primary prevention of cardiovascular events among individuals with relatively low levels of LDL-C and elevated hsCRP.

What criteria should be used to assess if a biomarker is suitable for cardiovascular risk prediction? Dr. Ridker discusses some recent controversy around this issue, and finally where we are going in terms of multi-marker and genomic approaches to risk stratification.

Copyright © 2007 E-MedHosting.com Inc.

After viewing this presentation the participant will be able to discuss:

- Biomarkers shown to be independent predictors of myocardial infarction and stroke
- What features make a biomarker useful in cardiovascular risk prediction?
- Recent data on hsCRP and cardiovascular risk stratification
- Future perspectives: multi-marker and genomic approaches

1. Cook NR, Buring JE, Ridker PM. The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann. Intern. Med. 2006 Jul 4;145(1):21-9.

2. Paul M. Ridker, MD; Nader Rifai, PhD; Marc A. Pfeffer, MD; Frank M. Sacks, MD; Lemuel A. Moye, MD, PhD; Steven Goldman, MD; Greg C. Flaker, MD; Eugene Braunwald, MD; ; for the Cholesterol and Recurrent Events (CARE) InvestigatorsInflammation, Pravastatin, and the Risk of Coronary Events After Myocardial Infarction in Patients With Average Cholesterol Levels Circulation. 1998;98:839-844.

3. Paul M. Ridker, M.D., M.P.H., Nader Rifai, Ph.D., Michael Clearfield, D.O., John R. Downs, M.D., Stephen E. Weis, D.O., J. Shawn Miles, M.D., Antonio M. Gotto, Jr., M.D., D.Phil., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events N Engl J Med. 2001 Jun 28;344(26):1959-65.