Biomarkers of Cardiovascular Disorders - Applications of Biotechnology in Cardiovascular Therapeutics - page 122

Role of Biomarkers in the Management
of Cardiovascular Disease
Role of Biomarkers in the Diagnosis/Prognosis
of Myocardial Infarction
According to the World Health Organization, the diagnosis of myocardial infarction
requires that two out of the following three criteria be met:
1. Clinical history of ischemic type chest pain for at least 20 min
2. Changes in serial ECG tracings
3. Rise and fall of serum cardiac enzymes (biomarkers)
BNP/NT-proBNP and CRP are mentioned in the current guidelines of the
European Society of Cardiology as appropriate biomarkers for risk stratification of
myocardial infarction, whereas clinical relevance of other novel biomarkers
remains uncertain and necessitates further studies (Weber and Hamm 2008 ).
According to a 2009 Henry Ford Hospital (Detroit, MI) study, many patients
with myocardial infarction have high levels of cardiac biomarkers in the blood for
several months after leaving the hospital, with more shortness of breath and chest
pain. The study examined a subset of patients in a 4,500-patient heart attack regis-
try from 24 US hospitals and found that 6 months later 9% percent had elevated
levels of the TnT and 33% had elevated level of the BNP/NT. These elevated bio-
markers were definitely associated with a reduced quality of life for patients and
worse outcomes. This data raises two important issues; (1) whether the biomarkers
are a sign of ongoing problems or a reflection of the past myocardial infarction, and
(2) whether closer monitoring of patients post-myocarial infarction can help target
the treatment to those who need it most.
Role of Biomarkers in the Prevention of Cardiovascular Disease
Preventive treatment for those most at risk of heart disease rather than those with
the highest blood pressure or cholesterol values may be a more efficacious strategy
for disease management. This depends on accurate biomarker-based risk assess-
ment tools. An evidence-based model of heart disease risk was developed using the
Framingham model with an additional five risk factors, including three of the
newer blood biomarkers (Root and Smith 2005 ). This was applied to the adult
population of the 3rd National Health and Nutrition Examination Survey cohort.
Additionally, the selection criteria for therapeutic intervention from the Adult
Treatment Panel III guidelines (for hyperlipidemia) and the 7th Report of the Joint
National Committee (for hypertension) were applied to the same subjects. Of this cohort,