Affiliations: Department of Medical Sciences, Uppsala University,
Uppsala, Sweden
Note: [] Corresponding author: Johan Sundström, MD PhD, Department of
Medical Sciences, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Tel.:
+46 18 6119889 or +46 70 4225220; Fax: +46 18 509297; E-mail:
johan.sundstrom@medsci.uu.se
Abstract: The identification of those persons in the population who have the
highest risk of future cardiovascular events is important for targeting
intensive preventive efforts. This can be reliably done using a handful of long
since established risk factors. The unmet need for new molecular biomarkers for
prediction of cardiovascular events in the general population is therefore low.
In order for a new biomarker to be used clinically for risk prediction, a
statistically significant association of levels of the biomarker to adverse
outcome is not enough, but the biomarker should also be demonstrated to add
discriminative capacity beyond established risk factors. In contrast to the
limited value of new biomarkers for risk prediction, their usefulness for
unraveling the pathophysiology of cardiovascular disease is large. The
myocardium is the source of a vast number of interesting biomarkers, of which a
few may be useful for risk prediction in the general population. Two of these,
troponin-I and the N-terminal fragment of brain natriuretic peptide, have
passed tests of added discriminatory value. Numerous other biomarkers produced
by cardiomyocytes or non-cardiomyocytes in the myocardium are promising, and if
they are not proven useful for risk prediction, they will unquestionably
enhance our understanding of cardiovascular disease.
