The Use of Blood Biomarkers in Precision Medicine for the Primary Prevention of Atherosclerotic Cardiovascular Disease: a Review.
The Use of Blood Biomarkers in Precision Medicine for the Primary Prevention of Atherosclerotic Cardiovascular Disease: a Review.
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DOI：
10.1080/23808993.2021.1930531
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发表时间：
2021
影响因子：
1.2
通讯作者：
Michos ED
中科院分区：
文献类型：
--
作者：
Sweeney T;Quispe R;Das T;Juraschek SP;Martin SS;Michos ED
生物标志物是指示疾病、感染或环境暴露存在的物质、结构或过程。临床上有用的生物标志物是可测量的，改善诊断或预后性能，并最终帮助临床医生确定治疗的开始，持续时间或幅度。本综述的目的是探讨动脉粥样硬化性心血管疾病（ASCVD）的各种血液生物标志物的作用，以及它们的使用如何提高临床医生识别，治疗和最终预防ASCVD的精度。我们的综述将包括脂质生物标志物、心脏损伤和室壁应力的标志物、炎症标志物和其他一些标志物。最近，在2019年美国心脏病学会/美国心脏协会ASCVD一级预防指南中，几种生物标志物被强调为“风险增强因素”，这有助于指导共同决策。这些包括低密度脂蛋白胆固醇、甘油三酯、脂蛋白（a）、载脂蛋白B或高敏C反应蛋白升高。然而，本综述中提到的其他一些生物标志物并不常用，尽管最初显示出预测ASCVD风险的希望，因为尚不清楚在无症状个体中测量后应如何改变治疗决定。未来的研究应集中在生物标志物导向的管理策略是否可以改善临床结果。
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. 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. 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.