Cardiac Risk Assessment

The actual and global assessment of cardiac risk forms an important step in the prevention and management of coronary heart disease (CHD).^1-3 The importance of accurately identifying the risk for cardiac disease can be emphasized by the fact that patients without clinically evident CHD may be at a similar or even higher risk of experiencing a cardiovascular event compared to individuals with a previous history of myocardial infarction (MI).

Risk Factors

Several factors that increase the risk of coronary heart disease have been identified and studied extensively.

Non-modifiable	Modifiable
Gender: Higher in men than premenopausal women	Active and passive smoking
Age: Male > 45 years Female > 55 years	Low physical activity and obesity
Family History: CHD in close relatives and/or premature CHD	Diabetes mellitus and hypertension
Ethnicity and Race: African Americans, Hispanic Americans, Japanese and Chinese are more prone to suffer stroke	Unhealthy diet: Increased intake of saturated fats

Global Cardiac Risk Score Algorithms

The need for timely and precise identification of patients at high risk for CHD has led to the development of various risk assessment tools. A patient’s risk for cardiac disease can be assessed using the following algorithms:

Framingham Score Assessment
Framingham assessment, recommended by the American Heart Association (AHA),⁴ is a risk-scoring system developed from the Framingham Heart Study.⁴ It estimates the risk of MI or coronary death within 10 years, independently for men and women.

PROCAM Risk Score
This scoring system, recommended by the International Task Force for Prevention of Coronary Heart Disease, is based on the German PROCAM Münster Heart Study.⁶ The system estimates the risk of developing a fatal or non-fatal myocardial infarction or sudden death due to CHD in the next 10 years.

Risk Factors Considered for Framingham and PROCAM Assessment

Risk Factors	PROCAM⁶	Framingham⁴
Age and gender	X	X
Total cholesterol		X
HDL-C	X	X
LDL-C	X
Triglycerides	X
Smoking	X	X
Systolic blood pressure	X	X
Diabetes	X	X
Family history of coronary heart disease	X

Emerging and Extended Risk Factor Panel

Apart from the conventional established risk factors, a large number of non-classical factors have been recognized in recent years that are associated with an enhanced risk of coronary events.²

Emerging Risk Factor Panel⁵	Extended Risk Factor Panel
hsCRP	Apolipoprotein A-1
Homocysteine	Apolipoprotein B
Lipoprotein (a)	Apo B / Apo A-1 ratio
Genetic markers	Cystatin C
Increased coronary calcium score	BNP or NT-proBNP
	Albumin in urine

Biomarkers for Cardiac Risk Assessment

Risk assessment using cardiac biomarkers focuses on the identification of four major pathological conditions.

Dyslipidemia
Characterized by elevated plasma cholesterol and/or triglycerides, or low HDL levels, contributing to the development of atherosclerosis
The biomarkers useful in identifying dyslipidemia include:
- Total Cholesterol (TC)
- High-density lipoprotein- Cholesterol (HDL-C)
- Low-density lipoprotein- Cholesterol (LDL-C)
- Triglycerides
- Apolipoprotein B (apoB)
- Apolipoprotein A-1 (apoA-1)
- Lipoprotein (a) [Lp(a)]
Atherosclerosis
The build-up of plaque in the inner walls of arteries, which results in reduced flow of oxygen-rich blood to various parts of the body
The biomarkers useful in identifying atherosclerosis include:
- Fibrinogen
- hsCRP
- Myeloperoxidase
Hyperhomocysteinemia
Hyperhomocysteinemia, characterized by elevated levels of serum homocysteine, has been identified as a potential risk factor for atherosclerotic disease.
The biomarkers useful in identifying hyperhomocysteinemia include:
- Homocysteine
Left Ventricular Overload
An increase in the ventricular volume or mass, leading to contractile dysfunction, which may finally culminate in heart failure
The biomarkers useful in identifying left ventricular overload include:
- BNP
- NT-proBNP

Reliable Answers to Critical Cardiac Questions

As a recognized worldwide leader in CVD testing, Siemens Healthcare Diagnostics provides a comprehensive and expanding menu of cardiac biomarkers across a broad spectrum of instrument solutions that help identify patients at risk for cardiovascular disease.

Click here for our menu of risk assessment cardiac biomarkers.

Click here to learn more about our complete menu of cardiac biomarkers.

References:
1. World Health Organization. Fact sheet No 317. Feb 2007
View source. Accessed Dec 2008.
2. International Task Force for Prevention of Coronary Heart Disease / International Atherosclerosis Society. Pocket guide to prevention of coronary heart disease.
View source. Accessed Dec 2008.
3. De Backer, et al. Eur Heart J. 2003;24:1601-10.
View source.
4. American Heart Association. Heart Attack/Coronary Heart Disease Risk Assessment.
View source. Accessed December 2008.
5. Assmann G, et al. Nutr Metab Cardiovasc Dis. 2005;15:373-81.
View source.
6. Cullen P, et al. Circulation. 1997;96:2128-2136.
View source.