Established and emerging plasma biomarkers in the prediction of first atherothrombotic events

There is considerable pathophysiologic and clinical interest in the development of novel biomarkers for inflammation, hemostasis, thrombosis, and oxidative stress that may help in the detection of individuals at high risk for future vascular events. However, as outlined in Table 1, few of these markers have demonstrated an ability to predict risk over and above information available from global assessment tools such as the Framingham Risk Score, and no evidence is available demonstrating that specific reductions in any of these novel markers will lower vascular risk. Although this overview has focused on the role of biomarkers for prognosis in primary prevention, it remains possible that several biomarkers will prove useful for demonstrating efficacy of therapy or in predicting specific patient groups more or less likely to benefit from targeted interventions. It also remains probable that no single biomarker will emerge that provides appropriate information for all clinical settings; thus, multimarker approaches also need evaluation. Ongoing efforts in plasma-based biomarker research will simultaneously need to address novel pathways of disease and carefully evaluate clinical applications and clinical efficacy.