Dr. Thomas J. Wang, Cardiologist, Medicine Department, Massachusetts General Hospital
Should Biomarkers Be Assessed in All Healthy People?
Although the New England Journal of Medicine study confirmed that contemporary biomarkers are associated with the risk of CVD and death, Dr. Wang says that these biomarkers add only moderately to traditional risk factors when assessing the future risk of cardiovascular events in healthy people. “Even in cases when individuals had increased levels of the biomarkers we assessed, they were unlikely to experience an event during the follow-up period. Our data reemphasize the importance of assessing traditional risk factors for each individual. Our results don’t support the idea of screening large populations of healthy people for high levels of these biomarkers.”
Routine measurement of novel biomarkers would be justified if they added to clinicians’ ability to predict risk of death and future CVD events, according to Dr. Wang. “These biomarkers appeared to add only modestly to our predictive ability in the community-based population of people we examined.” However, Dr. Wang adds that it is important to note that the study assessed only healthy individuals. He concedes that the investigators did not examine patients who already had CVD. “Our conclusions cannot and do not exclude the possibility that these biomarkers could be useful in specific patient groups. For example, these biomarkers might more accurately stratify patients at intermediate risk as determined by traditional risk factors.”
The Next Mission: Identify New Biomarkers
Dr. Wang says that the next step in trying to identify healthy patients who are at risk for CVD is to continue using traditional risk factors in prediction models and to identify new biomarkers related to CVD. “There is hope that other biomarkers that have yet to be discovered may better predict and assess cardiovascular risk in healthy individuals,” he says. “While the traditional biomarkers we assessed in our study do contribute to CVD prediction when patients have the disease, they are not good enough to predict risk in healthy people.” Other possible biomarker candidates related to CVD have been identified in recent investigations. “The key now,” Dr. Wang says, “is to study these other biomarkers and determine if it’s possible that some of them may do a better job in healthy cohorts. More research is required, but there is optimism in that our current list of CVD biomarkers will increase in the next five to 10 years. When that happens, we may be able to substantially increase our ability to predict CVD risk in the general population.” Thomas J. Wang, MD has indicated to Physician’s Weekly that he has or has had no financial interests to report.
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