Biomarkers

Biomarkers, which are often used in conjunction with traditional risk factors, are subclinical indicators of physiological and pathological processes. Elevation of cardiac-related biomarkers can help identify individuals at increased risk of cardiovascular disease (CVD) incidence and progression who may benefit from more intensive medical therapy. Newer lipid measures can provide additional insights into atherosclerotic CVD risk beyond total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels. Additionally, other non-lipid biomarkers, including markers of inflammation, subclinical myocardial injury and wall stress, also appear to have utility in refining CVD risk estimation for a more patient-centered approach. Specifically, the 2019 American College of Cardiology/American Heart Association Guideline for the Primary Prevention of CVD has highlighted elevated high sensitivity C-reactive protein, triglycerides, apolipoprotein B, and lipoprotein(a) as the most helpful “risk-enhancing” factors, that if measured, would favor initiation or intensification of statin therapy among borderline or intermediate-risk individuals. In this chapter, we will review several key lipid-based biomarkers and non-lipid cardiac biomarkers. The goal is to provide clinicians a framework for how to best incorporate such biomarkers into clinical care for an individualized approach to CVD prevention and to identify gaps in knowledge that warrant further study.