New and emerging risk factors for CVD

Abstract

Morphological and immunocytochemical studies have elucidated the complex processes involved in atherogenesis. The notion of plaque instability has emerged from this work and underscored the importance of inflammation in determining clinical complications associated with atherosclerosis, such as acute coronary syndrome. Cells of the immune system have been detected within atherosclerotic lesions and auto-antibodies directed against modified LDL and heat-shock proteins have been identified in the blood of individuals with atherosclerosis. The use of risk 'engines', e.g. the Framingham coronary risk score, has facilitated the identification of individuals at high risk, but the constituent classical risk factors used in these algorithms do not adequately differentiate individuals at moderate risk. As age is a major component of the equations used in these algorithms they are not particularly useful in young adults, and their applicability to non-Caucasian populations has been questioned. Biomarkers of early disease and plaque instability have therefore both been sought. Although some of these markers have been shown individually to be associated with a significant hazard ratio, no substantial improvement in discrimination has been demonstrated when they are incorporated into a risk 'engine'. The latter has generally been assessed by receiver operator characteristic curve analysis, although this approach has been criticised. Other modalities, including imaging and functional assessments of vascular function, are now being developed for clinical use. CVD: Risk factors: Plaque instability: Biomarkers of early CVDThe UK prevalence of cardiovascular mortality remains amongst the highest in the world, accounting for approximately one-third of all deaths (1) . Atherosclerosis is now recognised as a chronic inflammatory condition, and remains as the major cause of CVD (2) . It is characterised by luminal narrowing of arteries and is associated with the deposition of lipid and matrix proteins in the blood-vessel wall (3) . A high risk of CVD is associated with abnormalities in lipid metabolism, hypertension and diabetes mellitus (4) , associations supported by landmark primary and secondary intervention trials (5,6) . These studies have contributed to the development of risk calculators and guidelines for the management of CVD (4,7) . The Framingham risk score (8) and Prospective Cardiovascular Münster (PROCAM) algorithm (9) are perhaps the best known of the risk 'engines', and are based on prospective cohort studies from well-characterised Caucasian populations living in the USA and Germany respectively. Deficiencies have been recognised in extending the data from these cohort studies to individual patients. For example, ethnicity, family history and adiposity are factors that were not originally considered, but for which corrections have been advocated in recent guidelines (4) . The risk 'engines' also underestimate the absolute risk of patients with preexisting CVD and diabetes, and it is therefore no longer recommen...

Does intake of bread supplemented with wheat germ have a preventive role on cardiovascular disease risk markers in healthy volunteers? A randomised, controlled, crossover trial.

“…Cardiovascular diseases (CVD) remain the leading cause of mortality in the world, having accounted for 15 million of deaths in 2015 1. Risk factors for CVD are well-identified and they include smoking, type 2 diabetes or high glucose levels, hypertension and elevated cholesterol levels 2. Diet is therefore an important modifiable risk factor for CVD and, within the diet, some dietary components may have an important preventive role 3–5.…”

Changes in Plasma Level of Heat Shock Protein 27 After Acute Coronary Syndrome

“…But several emerging risk factors for cardiovascular disease have been reported including oxidative stress, inflammation, and autoimmunity. 2 Heat shock proteins (Hsps) are highly conserved families of proteins found in the cells of all organisms. Several Hsps are known to function as molecular chaperones.…”

“…But several emerging risk factors for cardiovascular disease have been reported including oxidative stress, inflammation, and autoimmunity. 2…”

Effect of Obesity on Cardiovascular Disease Risk Factors in African American Women

“…Although these traditional risk factors are useful for cardiovascular risk stratification, researchers continue to debate the generalizability of these findings given the homogeneity of the original study sample population. In recent times, researchers have begun exploring obesity’s association with new and novel biomarkers (Eaton, 2005; Ferns, 2008; Lastra-Gonzalez, Manrique, Govindarajan, Whaley-Connell, & Sowers, 2005; Prabhakaran & Anand, 2004).…”