The use of blood biomarkers in precision medicine for the primary prevention of atherosclerotic cardiovascular disease: a review

ABSTRACT

Introduction: A biomarker is a substance, structure, or process that indicates the presence of a disease, infection, or environmental exposure. Clinically useful biomarkers are measurable, improve diagnostic or prognostic performance, and ultimately aid clinicians in determining the initiation, duration, or magnitude of therapy.

Areas Covered: The purpose of this review is to explore the roles of various blood biomarkers of atherosclerotic cardiovascular disease (ASCVD) and how their use may improve the precision with which clinicians can identify, treat, and ultimately prevent ASCVD. Our review will include lipid biomarkers, markers of cardiac injury and wall stress, markers of inflammation, and a few others.

Expert Opinion: Several biomarkers have recently been highlighted as ‘risk-enhancing factors’ in the 2019 American College of Cardiology/American Heart Association Guideline for the Primary Prevention of ASCVD, which can help guide shared decision-making. These included elevated low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), apolipoprotein B, or high-sensitivity C-reactive protein. However, some other biomarkers mentioned in this review are not commonly used despite showing initial promise as prognostic of ASCVD risk as it is not clear how treatment decisions should be changed after their measurement among asymptomatic individuals. Future studies should focus on whether biomarker-directed management strategies can improve clinical outcomes.

KEYWORDS:

• Biomarkers
• atherosclerotic cardiovascular disease
• precision medicine
• lipids
• inflammation
• cardiac injury
• cardiac wall stress

Declaration of interest

Dr. Martin has served on scientific advisory boards and received consulting fees in the last 36 months from AstraZeneca, Amgen, Esperion, Kaneka, Novo Nordisk, Regeneron, REGENXBIO, Sanofi, and 89bio. He is a co-inventor on a system to estimate LDL cholesterol levels, patent application pending. He is a founder of and holds equity in Corrie Health, which intends to further develop the platform. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

Dr. Michos is supported by the Amato Fund in Women’s Cardiovascular Health Research at the Johns Hopkins University School of Medicine and by grants from the American Heart Association (20SFRN35120152 and 20SFRN35380046). Dr. Juraschek is supported by the National Heart, Lung, and Blood Institute grants K23HL135273 and R21HL144876. Dr. Quispe is supported by an NIH T32 training grant (5T32HL007227). Dr. Martin is supported by the American Heart Association (20SFRN35380046 and COVID19-811000), PCORI (ME-2019C1-15328), NIH (P01 HL108800), and the David and June Trone Family Foundation.