New risk markers beyond lipids and hs-CRP

The extent to which the classical cardiovascular disease (CVD) risk factors can predict clinical events is a matter of debate. Hundreds of novel risk factors have been nominated and any that play a causative role would offer the possibility of treatment innovation. On the other hand, consistent proof of independent, causative risk factors has been difficult to establish. The most promising markers often struggle to improve risk prediction, even when used in combination. Furthermore, the statistical methods used in many positive studies have been criticised as a source of over-optimistic results. The current practical approach involves the use of some markers to reclassify intermediate risk subjects into high and low risk categories. It is now recognised that CVD may arise through a variety of mechanisms, and that patterns may vary as a consequence of ethnic and socio-economic factors. In future, laboratory risk markers are likely to be used in conjunction with other non-invasive techniques, such as imaging, which may be able to detect pre-clinical CVD. Other challenges include the identification of genetic markers by genome-wide association studies. These genetic markers imply yet-to-be-detected risk markers and therapies. Finally, the paradigm of risk factor measurement and control faces competing philosophies such as universal treatment or non-invasive monitoring.