alexa Critical appraisal of inflammatory markers in cardiovascular risk stratification.
Biochemistry

Biochemistry

Clinical & Medical Biochemistry

Author(s): Krintus M, Kozinski M, Kubica J, Sypniewska G

Abstract Share this page

Abstract Despite great progress in prevention strategies, pharmacotherapy and interventional treatment of coronary artery disease (CAD), cardiovascular events still constitute the leading cause of mortality and morbidity in the modern world. Traditional risk factors, including hypertension, diabetes mellitus, smoking, obesity, dyslipidemia, and positive family history account for the occurrence of the majority of these events, but not all of them. Adequate risk assessment remains the most challenging in individuals classified into low or intermediate risk categories. Inflammation plays a key role in the initiation and promotion of atherosclerosis and may lead to acute coronary syndrome (ACS) by the induction of plaque instability. For this reason, numerous inflammatory markers have been extensively investigated as potential candidates for the enhancement of cardiovascular risk assessment. This review aims to critically assess the clinical utility of well-established (C-reactive protein [CRP] and fibrinogen), newer (lipoprotein-associated phospholipase A2 [Lp-PLA2] and myeloperoxidase [MPO]) and novel (growth differentiation factor-15 [GDF-15]) inflammatory markers which, reflect different pathophysiological pathways underlying CAD. Although according to the traditional approach all discussed inflammatory markers were shown to be associated with the risk of future cardiovascular events in individuals with and without CAD, their clear clinical utility remains not fully elucidated. Current recommendations of numerous scientific societies predominantly advocate routine assessment of CRP in healthy people with intermediate cardiovascular risk. However, these recommendations substantially vary in their strength among particular societies. These discrepancies have a multifactorial background, including: (i) the strong prognostic value of CRP supported by solid scientific evidence and proven to be comparable in magnitude with that of total and high-density lipoprotein cholesterol, or hypertension, (ii) favourable analytical characteristics of commercially available CRP assays, (iii) lack of CRP specificity and causal relationship between CRP concentration and cardiovascular risk, and (iv) CRP dependence on other classical risk factors. Of major importance, CRP measurement in healthy men ≥50 years of age or healthy women ≥60 years of age with low-density lipoprotein cholesterol <130 mg/dL may be helpful in the selection of patients for statin therapy. Additionally, evaluation of CRP and fibrinogen or Lp-PLA2 may be considered to facilitate risk stratification in ACS patients and in healthy individuals with intermediate cardiovascular risk, respectively. Nevertheless, the clinical utility of CRP requires further investigation in a broad spectrum of CAD patients, while other promising inflammatory markers, particularly GDF-15 and Lp-PLA2, should be tested in individuals both with and without established CAD. Further studies should also focus on novel performance metrics such as measures of discrimination, calibration and reclassification, in order to better address the clinical utility of investigated biomarkers and to avoid misleadingly optimistic results. It also has to be emphasized that, due to the multifactorial pathogenesis of CAD, detailed risk stratification remains a complex process also involving, beyond assessment of inflammatory biomarkers, the patient's clinical characteristics, results of imaging examinations, electrocardiographic findings and other laboratory parameters (e.g. lipid profile, indices of renal function, markers of left ventricular overload and fibrosis, and biomarkers of myocardial necrosis, preferably cardiac troponins). This article was published in Crit Rev Clin Lab Sci and referenced in Clinical & Medical Biochemistry

Relevant Expert PPTs

Relevant Speaker PPTs

  • Ping Gu
    Myeloid-specific deletion of SIRT1 impairs obesity and ageing-associated endothelial dysfunction
    PPT Version | PDF Version
  • George Rawitscher
    Revival of the phase-amplitude description of a quantum-mechanical wave function
    PDF Version
  • Tina Cloney
    Behavioral change strategies conducive to reducing rates of disease and disability and promoting rehabilitation and daily functioning
    PPT Version | PDF Version
  • Khalid Bashar
    Predictive parameters of arterio-venous fistula functional maturation in a population of patients with end-stage renal disease
    PPT Version | PDF Version
  • Cormac G M Gahan
    Bacterial bile salt hydrolase in the regulation of host lipid metabolism and circadian rhythm: A role in probiotic function?
    PPT Version | PDF Version
  • Thomas Kieber-Emmons
    Developing a first in man carbohydrate mimetic peptide vaccine for cancer: A translational story
    PDF Version
  • Tjale Mahopo
    Impact of infant feeding practices on gut function in Dzimauli community, South Africa
    PDF Version
  • Keiko Unno
    Prevention of cognitive dysfunction and amyloid beta accumulation by the ingestion of green soybean extract in aged mice
    PDF Version
  • Chia-chi Liu
    Oxidative inhibition of erythrocyte sodium pump: A functionally relevant circulating marker of oxidative stress
    PPT Version | PDF Version
  • Yosef Yarden
    Classically, the 3’untranslated region (3’UTR) is that region in eukaryotic protein-coding genes from the translation termination codon to the polyA signal. It is transcribed as an integral part of the mRNA encoded by the gene. However, there exists another kind of RNA, which consists of the 3’UTR alone, without all other elements in mRNA such as 5’UTR and coding region. The importance of independent 3’UTR RNA (referred as I3’UTR) was prompted by results of artificially introducing such RNA species into malignant mammalian cells. Since 1991, we found that the middle part of the 3’UTR of the human nuclear factor for interleukin-6 (NF-IL6) or C/EBP gene exerted tumor suppression effect in vivo. Our subsequent studies showed that transfection of C/EBP 3’UTR led to down-regulation of several genes favorable for malignancy and to up-regulation of some genes favorable for phenotypic reversion. Also, it was shown that the sequences near the termini of the C/EBP 3’UTR were important for its tumor suppression activity. Then, the C/EBP 3’UTR was found to directly inhibit the phosphorylation activity of protein kinase CPKC in SMMC-7721, a hepatocarcinoma cell line. Recently, an AU-rich region in the C/EBP 3’UTR was found also to be responsible for its tumor suppression. Recently we have also found evidence that the independent C/EBP 3’UTR RNA is actually exists in human tissues, such as fetal liver and heart, pregnant uterus, senescent fibroblasts etc. Through 1990’s to 2000’s, world scientists found several 3’UTR RNAs that functioned as artificial independent RNAs in cancer cells and resulted in tumor suppression. Interestingly, majority of genes for these RNAs have promoter-like structures in their 3’UTR regions, although the existence of their transcribed products as independent 3’UTR RNAs is still to be confirmed. Our studies indicate that the independent 3’UTR RNA is a novel non-coding RNA species whose function should be the regulation not of the expression of their original mRNA, but of some essential life activities of the cell as a whole.
    PPT Version | PDF Version
  • Alina Borowska
    Postoperative cognitive dysfunctions after cardiac operations
    PPT Version | PDF Version
  • Elena Rampanelli
    Renal dysfunction and metabolic syndrome: the chicken or the egg?
    PPT Version | PDF Version
  • Maha M Saber
    Honey as nutrient and functional food
    PPT Version | PDF Version
  • Cecilia H. Marzabadi
    NOVEL CARBOHYDRATE-BASED LIGANDS WITH IMMUNOSTIMULATORYPROPERTIES
    PPT Version | PDF Version
  • Vladimir Sulimov
    “Vladimir Sulimov-Dimonta-Ltd-and-Lomonosov-Moscow-State-University-Russia-Protein-ligand-low-energy-minima-pose-analysis-Docking-target-functions-evaluation-with-the-FLM-program”
    PPT Version | PDF Version

Recommended Conferences

  • 2nd International Conference on Biochemistry
    Sep 21-22, 2017 Macau, Hong Kong
  • 7th International Conference on Predictive, Preventive and Personalized Medicine & Molecular Diagnostics
    Oct 23-25, 2017 Chicago, USA
  • International Conference on Biotech Pharmaceuticals
    October 23-25, 2017 Paris, France

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords