Cardiac risk factors: biomarkers and genetic tests to determine cardiovascular risk.

Current guidelines recommend global risk assessment instruments as the primary approach for determining risk of coronary heart disease (CHD). The Framingham Risk Score (FRS) yields a 10-year risk of CHD, whereas the newer Pooled Cohort Equations yield a 10-year risk of stroke or CHD. High-sensitivity C-reactive protein, a biomarker for inflammation, along with family history of CHD, can be added to the parameters of the FRS in the Reynolds Risk Score to yield a more refined 10-year CHD risk. Various other biomarkers also can be used. Patients with elevated urinary albumin have higher rates of CHD events, though the incremental yield of adding urinary albumin provides only minor improvements in risk assessment compared with the FRS. Elevated levels of lipoprotein (a) [Lp(a)] also predict increased risk of CHD, and some guidelines recommend Lp(a) testing for patients with strong family histories of premature CHD. Another biomarker is platelet-activating factor acetylhydrolase (Lp-PLA2). Elevated levels indicate increased risk, and some recommendations suggest a lower goal level for low-density lipoprotein with statin therapy when Lp-PLA2 levels are high. Finally, genome-wide association studies for genetic risk of CHD currently are not recommended, but such tests likely will be useful within the next few years.