New issues in the screening and prevention of cardiovascular disease

Conventional risk factor assessment by the use of the Framingham criteria is sufficient to assess risk in more than 90% of patients. However, it misses some patients at high risk and delays the chances for earlier primary prevention. Most likely, future risk assessment will incorporate several novel biomarkers in addition to the lipid profile. Because of their low cost, availability, and the fact that the patient need not fast, tests for levels of hs-CRP, apolipoprotein B, and apolipoprotein A-1 are most likely to be incorporated into risk assessment algorithms. Clinical outcome trials are required for each of these biomarkers to identify levels that mandate treatment and to show that treatment of abnormal levels leads to a reduction in clinical events. The JUPITER trial should provide the first clinical information about hs-CRP and go a long way toward solidifying or negating its relevance as an additional biomarker for risk assessment.