Cardiovascular biomarkers: A risky business
- PDF / 119,736 Bytes
- 3 Pages / 612 x 792 pts (letter) Page_size
- 87 Downloads / 168 Views
Cardiovascular Biomarkers: A Risky Business Maral Ouzounian, MD, Douglas S. Lee, MD, PhD, and Peter P. Liu, MD
Corresponding author Peter P. Liu, MD Institute of Circulatory and Respiratory Health, CIHR, NCSB 11-1266, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. E-mail: [email protected] Current Cardiovascular Risk Reports 2007, 1:177– 7 179 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2007 by Current Medicine Group LLC
Introduction Accurate risk assessment and prognostication are the cornerstones of comprehensive cardiovascular care. Therapeutic decisions are based on predictions of an individual’s clinical course with or without a given intervention. Risk-benefit analysis guides the healthcare provider who synthesizes all available data to inform in patient management. These data have evolved from empirical anecdotes and conventional wisdom to sophisticated multivariable risk profiles, incorporating detailed demographic, clinical, biochemical, and imaging information. Accurate risk assessment tools may refine diagnosis and prognosis, guide disease-modifying interventions, and monitor response to therapy. The goal of these strategies is to delay or prevent the initiation or progression of cardiovascular disease, ultimately reducing the burden of illness for the individual and society.
Intervention: How Soon is Soon Enough? Typical current intervention in cardiac disease occurs well after irreversible molecular and structural changes have occurred. Patients with heart failure (HF) most often come to medical attention because of fluid retention or symptoms of exercise intolerance due to dyspnea or fatigue. Treatment for end-stage refractory HF is limited to either supportive care or extraordinary measures, such as mechanical support or cardiac transplantation. Similarly, due in part to a lack of effective screening tools, patients with coronary artery disease (CAD) also present at advanced stages, at which point even revascularization is also palliative.
Optimal disease management may be considered to begin before the first clinical manifestations arise. The care of such preclinical disease necessitates presymptomatic prediction of illness. Current methods of prevention rely on our understanding of the genesis and progression of disease. An example is the treatment of hypertension to promote regression of left ventricular hypertrophy and prevent HF. Ideally, the point of intervention would be primordial and would occur prior to the development of hypertension based on clinical and genotypic information. An individual’s genetic code confers a baseline susceptibility to disease, which is modified throughout a lifetime by gene-gene and gene-environment interactions. Although an individual’s nucleotide sequence may not be presently modifiable, the genotype-phenotype correlation can be altered for complex genetic diseases. Individuals with high-risk single nucleotide polymorphisms (SNPs) may experience an accentuated benefit from targeted counseling to reduce the eve
Data Loading...
