It Could Be You

By Peter Galvin, MD

Early identification of individuals in the general population at high risk for atherosclerotic cardiovascular disease (CVD) (i.e., stroke, heart attack) shapes primary preventive strategies to reduce the risk of developing the disease. There are risk scores based on traditional risk factors, like the presence of hypertension or diabetes, for CVD such as SCORE2, the American Heart Association/American College of Cardiology Pooled Cohort Equations and PREVENT equations. But these scores merely assess risk based on the odds of developing the disease, in other words a calculated guess. A recent large study out of Hamburg, Germany, has identified a way to actually measure the risk of developing CVD.

Cardiac biomarkers, such as cardiac troponin, natriuretic peptides, and C-reactive protein (CRP), are established in clinical practice. Using newer, high-sensitivity assays, concentrations become measurable in the general population, opening up the prospects for a broader application of these biomarkers. Several prior studies have reported strong association of these biomarkers with CVD events (strokes, heart attacks) in those with known CVD but also, and most importantly, in those who were apparently healthy. The Hamburg study took this one step further. In this huge study across four continents and over 12 years, they measured levels of these high-sensitivity biomarkers over time in healthy volunteers. What they discovered is astounding.

First, all investigated biomarkers were predictors of not only incident atherosclerotic CVD events, but also of all-cause mortality, heart failure, heart attack, and ischemic stroke. Also, there was a stronger association of elevated biomarkers with all-cause mortality, especially heart failure, compared to fatal and non-fatal CVD events. In addition, prior studies of these biomarkers showed their predictive value lessened in older individuals, but in this study, which looked at the biomarkers collectively, the predictive value was actually greater in older individuals (aged 65 and up).

What does all this mean? It means that we finally may have a way to accurately predict who may develop atherosclerotic CVD years before they actually get it, allowing clinicians to attempt to modify an individual’s risk factors (such as elevated blood pressure, weight, smoking, diabetic control) to lessen the risk that he/she will develop CVD in the future. Now, rather than using a score to make a calculated guess as to future CVD, we have a way to accurately measure that risk, including the risk of early death.

So, the next time you see your clinician for a checkup, ask that your bloodwork include the following biomarkers: high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B type natriuretic peptide, B-type natriuretic peptide, and high-sensitivity C-reactive protein. Even if you already have CVD, these markers may help your clinician predict your risk of not just future CVD events, but possibly early death.

Questions or comments can be sent to editor@rockawaytimes.com