Further information that adds value to the results of conventional risk factor assessment can be obtained by the measurement of other factors that promote the disease or reflect the activity or extent of the disease process itself. These parameters are collectively termed “Biomarkers”. These parameters are not routinely offered in the NHS for the prevention of CVD, but are offered by CVD prevention specialists in the private sector in the UK and Western Europe and more widely in the USA.
Biomarkers of disease can be divided into 2 categories; those that can be measured in the blood and direct assessment of the arterial system for signs of disease.
Blood tests to calculate CVD Risk
hsCRP - High Sensitivity C-Reactive Protein is a general marker of
inflammation that has been shown to help identify an increased risk of CV events over and above conventional risk factors in many clinical studies.
Lipoprotein subfractions - Very detailed assessment of the size and density of the particles that carry cholesterol in the bloodstream. This can provide insights into their potential future contribution to the development of atherosclerotic plaque
Apolipoproteins A and B - Provide a more detailed assessment of the lipid profile that together with the routine lipid profile allows estimation of particle size. It is quicker, easier and cheaper to measure Apolipoproteins than lipoprotein subfractions, although slightly less accurate.
Lipoprotein (a) - A marker of risk of accelerated atherosclerosis and acute events, particularly in high risk families and when other risk factors are present
Lp-PLA2 - Lipoprotein-Associated Phospholipase A2 is an enzyme that influences the biology of LDL particles promoting inflammation in atherosclerotic plaque. A marker of “plaque instability” increased LpPLA2 levels are associated with an increased risk of heart attack and stroke. (Ref Davidson et al AJC 2008)
Insulin - Fasting insulin levels together with fasting glucose allows more detailed estimation of glucose regulation and diabetes risk.
BNP - Brain Natriuretic Peptide is a marker of cardiac “stress”. Used as a diagnostic test for heart failure, higher BNP levels may also help identify those at increased cardiac risk even in the absence of heart failure