Update on integrated biomarkers for assessment of long-term risk of cardiovascular complications in initially healthy subjects and patients with manifest atherosclerosis

Risk stratification for cardiovascular diseases (CVD) remains suboptimal even after the introduction of global risk assessment by various scores. This has prompted the search for additional biomarkers which might help to improve risk stratification. Basically, there are blood biomarkers representing various pathophysiological pathways of atherosclerosis, and markers of subclinical disease. Since inflammatory processes accompany all stages of atherosclerosis, measurement of plasma/serum concentrations of circulating inflammatory biomarkers have received great attention. Such biomarkers can be measured systemically by sensitive assays, and elevated concentrations in the circulation have been shown to be associated with future CVD events. Thus, they might add to the predictive value of the atherogenic lipoprotein phenotype to further improve CVD risk assessment. In addition, several non-invasive imaging techniques are available for which also a predictive value for CVD could be established. However, for most of these biomarkers the clinical utility has not yet been firmly established. This review attempts to give an update on the potential use of biomarkers for risk stratification in initially healthy subjects and patients with manifest, chronic atherosclerosis, particularly focusing on the integrated value of the combination of these markers.