A multi-biomarker blood and urine test designed to estimate future cardiovascular risk is in the news at present, having been featured at the prestigious TedMed conference and written up on theheart.org.
The test comprises a panel of five biomarkers, each focussing on different phases on the atherosclerotic plaque development and rupture process. This seems to me to be an interesting and novel approach.
The company that provides the test, Cleveland Heart Lab, suggests that the F2-Isoprostane/Creatinine urinary ratio highlights oxidation and unhealthy lifestyles such as smoking, lack of exercise and obesity, apparently representing a long-term marker of cardiovascular risk.
The next two of the markers estimate intermediate cardiovascular risk. These are hS-CRP and urinary microalbumin.
Finally, in terms of assessing very near-term risk of cardiovascular events, myeloperoxidase and Lipoprotein-Associated Phospholipase-A2 are markers of a vulnerable plaque phenotype.
On the company's website there are several supportive studies.
On the whole I think this is an interesting approach, but of course much remains to be done. Generally, with the biomarker approach, only small incremental benefits over and above Framingham scoring have been demonstrated. I am more of an advocate for atherosclerosis imaging which is generally associated with a far higher relative risk of cardiovascular events if the test is positive.
Whilst the idea of a simple, relatively inexpensive blood test is appealing to both patients and their doctors, be positive and negative predictive values of the test must be known. It must also (or they must also) provide added value to Framingham risk scoring if it is to be of any use.
Does the biomarker panel change with either lifestyle modification or drug therapy?
Although not directly testing this particular panel of biomarkers, the HRP Bioimage study should hopefully provide some firm ground for the recommendation of either blood biomarkers, structural atherosclerosis imaging tests or both in the asymptomatic high-risk population.
If you have any thoughts on this please feel free to jot them down below.