There are different diagnostic strategies for the evaluation of acute chest pain, each of which is based on a different pathophysiology. Dr. Ridker, however, suggests that there are better ways to deal with risk stratification in acute ischemia.

The multimarker approach measures biomarkers of acute ischemia, which range from first-degree messengers, such as IL-1, to acute-phase reactants, such as fibrinogen. Measuring troponin levels, for example, is a highly predictive method of detecting myocardial necrosis. So, too, is measuring high-sensitivity C-reactive protein (hs-CRP). Therefore, Dr. Ridker suggests combining several of these markers in order to better estimate the risk of recurring clinical events.

Another novel approach is using the proteome. An example given by Dr. Ridker is called 'planned myocardial ischemia'. It consists of exercise stress testing of a patient, with blood drawn before and immediately after the test, and using the findings to determine whether or not ischemia is present.

Another area of research aims to determine whether biomarkers can be used to target therapies. There's data to suggest the combination of LDL and hs-CRP levels measurements to be highly predictive of the benefits of being on statin therapy, and helpful in discriminating between different statin drugs.

Furthermore, Dr. Ridker demonstrates how significant demographic variables and blood biomarkers can be weaved into the Framingham risk score, which is the conventional algorithm used to determine cardiovascular risk. An example of this is the Reynolds risk score, which is useful in assessing the cardiovascular risk in patients with 'intermediate risk', as well as those who present no prior symptoms of disease, major risk factors, or abnormal cholesterol levels.

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After viewing this presentation the participant will be able to discuss different perspectives of risk stratification in acute ischemia:
-Multimarker approaches
-Proteomic approaches
-Targeted therapies
-Primary prevention

Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) InvestigatorsC-Reactive Protein Levels and Outcomes after Statin TherapyNEJM 2005;Volume 352:20-28.