Putting it into Perspective: Multimarker Panels for Cardiovascular Disease Risk Assessment

Abstract

Cardiovascular biomarkers started as tools to aid with specific medical diagnoses, but are now being used broadly for screening, prognosis and monitoring of multiple diseases. Novel markers that reflect important pathophysiologic pathways are emerging regularly, although each new set of markers introduced raises many questions on how best to utilize them to improve patient outcomes. One promising approach for getting the most out of cardiovascular biomarkers is to combine multiple markers together into a multimarker panel. When each marker represents a distinct pathophysiologic pathway, the combined panel has advantages over individual biomarkers and may be useful when used in specific clinical scenarios for assessing risk, improving diagnosis or directing individualized therapy. This perspective article highlights several of the most promising biomarkers and strategies for achieving improved cardiovascular risk assessment for primary prevention of cardiovascular disease via multimarker panels.

Multiplexed measurement of candidate blood protein biomarkers of heart failure

“…Recent studies indicate that shifting the focus from conventional risk factors and/or single disease biomarkers toward biomarker 'signatures', made up of multiple disease-relevant proteins, would be of considerable benefit in the management of HF. 3 Aside from cancer, cardiovascular research is the field in which novel disease biomarkers have been most extensively investigated, with more than 150 potential biomarkers for cardiovascular disease documented in the literature. 4 However, no new protein biomarker tests for HF have yet been approved and included in guidelines for use in clinical practice.…”

Pentraxin 3, ficolin-2 and lectin pathway associated serine protease MASP-3 as early predictors of myocardial infarction - the HUNT2 study

“…Inclusion of biomarker data significantly improved the AUC, and indicators of predictive ability such as the net reclassification index and integrated discrimination index indicated potential usefulness in clinical prediction. There is a growing interest in developing a multimarker approach for identifying cardiovascular risk 37 38 39 . The novel markers may be potential targets that can be included in a multimarker panel for predicting CVD and identifying individuals at higher risk of MI, above that of traditional risk factors.…”

Evaluation of Cardiac Toxicity Biomarkers in Rats from Different Laboratories

“…While assessing serum biomarkers is a promising strategy for early preclinical detection of potential drug-induced cardiac injury, some of these serum markers have limitations with poor cardiac specificity, sensitivity, and short half-life as well as inconsistency across species and low relevance to clinical outcome. Reverse translational application of established clinical biomarkers such as cardiac troponins and natriuretic peptides to preclinical models increases clinical relevance, and a multimarker approach offers the advantage of a more comprehensive assessment of risk (Pinsky and Zhu 2011; Taqui and Daniels 2013). Prominent elevation of NT-proANP and NT-proBNP concentrations detected at 24-hr postdose following single and multiple doses of MNX, a vasodilator that causes pericardial effusion in man and left ventricular hypertrophy (Moravec et al 1994; Reichgott 1981), suggest that these biomarkers can be used to detect the presence of or possibly predict the development of myocardial hypertrophy in the absence of direct cardiomyocyte injury.…”