New directions in cardiovascular risk assessment: the role of secondary risk stratification markers

Int J Clin Pract. 2012 Jul;66(7):622-30. doi: 10.1111/j.1742-1241.2012.02956.x.


Cardiovascular disease (CVD) risk screening is performed by multivariate methods relying on calculators derived from the Framingham study, other epidemiological studies or primary care records. However, it only identifies 70% of individuals at risk for CVD events and there has been interest in adding other risk factors to improve its predictive capacity. The addition of a family history of premature CVD is well established and there is evidence for adding lipoprotein (a) in some populations and possibly C-reactive protein may be suitable for general use in CVD risk assessment. Most new biochemical and imaging markers have been assessed in the context of improving risk classification in intermediate-risk groups rather than in the general population. There is evidence that N-terminal pro-B-type natriuretic peptide and coronary artery calcium score add significantly to risk prediction. The data for carotid intima-media thickness, ankle-brachial index are less strong and high sensitivity troponins look promising, but have had only limited data to date. Large scale meta-analyses ideally of pooled primary patient data will be required to determine the best additional markers to add to conventional risk prediction and in what groups to apply them.

Publication types

  • Review

MeSH terms

  • 1-Alkyl-2-acetylglycerophosphocholine Esterase / blood
  • Adrenomedullin / blood
  • Ankle Brachial Index
  • Arginine / analogs & derivatives
  • Arginine / blood
  • Biomarkers / blood
  • Blood Flow Velocity / physiology
  • C-Reactive Protein / metabolism
  • Cardiovascular Diseases / prevention & control*
  • Carotid Intima-Media Thickness
  • Early Diagnosis
  • Humans
  • Lipoprotein(a) / blood
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Protein Precursors / blood
  • Risk Assessment / methods
  • Risk Assessment / trends
  • Troponin / blood
  • Vascular Calcification / diagnosis
  • Vasodilation / physiology


  • Biomarkers
  • Lipoprotein(a)
  • Peptide Fragments
  • Protein Precursors
  • Troponin
  • mid-regional pro-adrenomedullin, human
  • Natriuretic Peptide, Brain
  • Adrenomedullin
  • N,N-dimethylarginine
  • C-Reactive Protein
  • Arginine
  • 1-Alkyl-2-acetylglycerophosphocholine Esterase