The Potential Role of Biomarkers Associated with ASCVD Risk: Risk-Enhancing Biomarkers

Abstract

Serum cholesterol is major risk factor and contributor to atherosclerotic cardiovascular disease (ASCVD). Therapeutic cholesterol-lowering drugs, especially statin, revealed that reduction in low-density lipoprotein cholesterol (LDL-C) produces marked reduction of ASCVD events. In the preventive scope, lower LDL-C is generally accepted as better in proven ASCVD patients and high-risk patient groups. However, in patients with low to intermediate risk without ASCVD, risk assessment is clinically guided by traditional major risk factors. In this group, the complement approach to detailed risk assessment about traditional major risk factors is needed. These non-traditional risk factors include ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, lipoprotein(a) (Lp[a]), apolipoprotein B (apoB), or coronary artery calcium (CAC) score. CAC measurements have an additive role in the decision to use statin therapy in non-diabetic patients 40-75 years old with intermediate risk in primary prevention. This review comprises ASCVD lipid/biomarkers other than CAC. The 2013 and 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines suggest these factors as risk-enhancing factors to help health care providers better determine individualized risk and treatment options especially regarding abnormal biomarkers. The recent 2018 Korean guidelines for management of dyslipidemia did not include these biomarkers in clinical decision making. The current review describes the current roles of hsCRP, ABI, LP(a), and apoB in personal modulation and management of health based on the 2018 ACC/AHA guideline on the management of blood cholesterol.

Keywords: Biomarkers; Cardiovascular disease; Risk assessment; Statins.

Fig. 1. Screening for subjects at risk for cardiovascular complications: blood biomarkers/risk factors and/or markers of subclinical disease.

BNP, b-type natriuretic peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; MR-proANP, mid-regional pro-A-type natriuretic peptide; GDF-15, growth differentiation factor-15; sST2, soluble suppression of tumorigenicity 2; sRAGE, serum soluble receptor for advanced glycation end products; eGFR, estimated glomerular filtration rate; IMT, intima-media thickness; CT, computed tomography; MRI, magnetic resonance imaging; FMD, flow-mediated dilation.

Fig. 2. Primary prevention: the role of ASCVD risk enhancer.

ASCVD, atherosclerotic cardiovascular disease; apoB, apolipoprotein B; CAC, coronary artery calcium; HIV, human immunodeficiency virus; hsCRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); CHD, coronary heart disease.