This paper by Ikonomidis et al. reviewed the utility of non-invasive markers of subclinical atherosclerosis (namely carotid intima media thickness, flow mediated dilatation of the brachial artery, augmentation index, or pulse wave velocity) in the prediction of cardiovascular risk. The authors stated that the multimarker approach, using either inflammatory markers (C-reactive protein, monocyte/macrophage colony-stimulating factor, and interleukin-6) or cumulative risk markers obtained from non-invasive tests or both, may be better than assessing a single marker and additive to combinations of traditional risk factors, particularly in primary prevention. However, the authors recognized that further large-scale multicentre trials investigating the prognostic value of such strategies are necessary to establish the clinical utility of these markers during risk stratification for cardiovascular disease and to discriminate the best, most cost-effective combination.
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