Novel markers for cardiovascular risk can be useful

In addition to the traditional lipid panel, novel biochemical markers can be used strategically by the clinician in evaluating and treating patients with cardiovascular risk, said John Holman, MD, Program Director, Camp Pendleton, San Diego.

"Half of CAD patients have below-average LDL-cholesterol levels, so there must be some other picture to add to this story," he said.

A $60 test, C-reactive protein (CRP) is a useful tool in intermediate-risk patients in whom the clinician might not otherwise initiate LDL-lowering therapy, said Dr. Holman.

Diet and aerobic exercise are effective in controlling elevated CRP, which "seems to be on the same risk level as elevated cholesterol", said Dr Holman. Statins lower the CRP count by 15% to 30%. Beta-blockers are also recommended.

Apolipoprotein B (ApoB) is an effective predictor of cardiovascular risk, he said. Some studies have found it to be even more accurate than LDL-cholesterol levels, he added. However, CRP is a more widely accepted screening tool because, for ApoB, agreed-upon thresholds for treatment and standardized assays   are not as developed, he noted.

An ApoB level above 120 mg/dL, the 75th percentile, has been identified by some as high risk. ApoB can be measured without fasting.

"The good news is that there is an automated and standardized assay. In my opinion, ApoB is going to become the new glamour marker," said Dr Holman.

Lipoprotein(a) is another marke,r and testing for it is recommended in certain high-risk patients, he said whereas other markers such as homocysteine, fibrinogen, and interleukin-6 are not recommended.