Biomarker Testing and Pre-emptive Therapy in Preventing Heart Failure
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HEART FAILURE PREVENTION (W TANG)
Biomarker Testing and Pre-emptive Therapy in Preventing Heart Failure Ken McDonald 1,2 & Mark Ledwidge 1 & Joe Gallagher 1 & Chris Watson 1,2
# Springer Science+Business Media New York 2015
Abstract In an attempt to reduce the heart failure epidemic, screening and prevention will become an increasing focus of management in the wider at-risk population. Refining risk prediction through the use of biomarkers in isolation or in combination is emerging as a critical step in this process. The utility of biomarkers to identify disease manifestations before the onset of symptoms and detrimental myocardial damage is proving to be valuable. In addition, biomarkers that predict the likelihood and rate of disease progression over time will help streamline and focus clinical efforts and therapeutic strategies. Importantly, several recent early intervention studies using biomarker strategies are promising and indicate that not only can new-onset heart failure be reduced but also the development of other cardiovascular conditions. Keywords Biomarkers . Heart failure . Cardiovascular disease prediction and prevention
be more productive with better quality of life and less costly in terms of health care expenditure. The essence of an effective prevention strategy is one which can predict accurately those at risk and apply to those an effective preventative strategy with proven ability for this to reduce events in a clinically significant and cost-effective manner. Heart failure prevention has still to adequately develop such a strategy. One of the major challenges in this area is the large number of patients who because of the presence of standard risk factors would be regarded as being at risk for heart failure. However, it is clear that the majority of these individuals never develop the syndrome. Accordingly, there is a need to refine risk prediction, to allow the focus of prevention strategies to be placed on a more manageable number of patients with heightened risk defined by novel screening approaches.
Biomarkers in Risk Stratification in Heart Failure Introduction With the changing demographic, there is an ever-increasing need for health care to focus on prevention in order to guide people through their middle to later years with as low a burden of chronic disease as is possible. In so doing, later decades will This article is part of the Topical Collection on Heart Failure Prevention * Ken McDonald [email protected] 1
St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
2
University College Dublin, Dublin, Ireland
Efforts have been made to fine tune clinical risk stratification for heart failure through use of biomarkers. Those studied in the main reflect either pathological processes thought relevant to later development of ventricular dysfunction and heart failure or the body’s response to those processes. The critical pathologies of relevance to asymptomatic ventricular dysfunction are inflammation, interstitial disease and myocyte hypertrophy and loss [1, 2]. Ac
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