Predicting the risk of coronary heart disease. II: the role of novel molecular biomarkers and genetics in estimating risk, and the future of risk prediction.

Description

The aim of this paper was to discuss the future of risk prediction through the use of novel molecular biomarkers and genetic markers. Several new biomarkers have been shown to be independently associated with coronary heart disease (CHD) and have been therefore studied for their discriminatory performance. These studies found that some biomarkers may have a role in risk assessment in specific clinical situations, but it seems unlikely that they will be of major public health importance. The interest in these novel biomarkers has been largely driven by the insights they provide into the pathogenesis of CHD rather than their inclusion in prediction models. A statistically significant association between a biomarker and disease occurrence is not enough to justify its inclusion in prediction models. The improvement in discrimination is illustrated by an increase of the area under the receiver operator characteristic curve. The discriminatory capacity of the risk model for cardiovascular disease and CHD is often unchanged by the addition of biomarkers to the multivariable model. A study investigated 19 novel biomarkers and none individually made a useful contribution to risk prediction. There are two categories of genetic research for the study of CHD, the candidate gene approach or the genome-wide association studies. However, genetic studies have not yet been able to identify genes that improved the discriminatory power of risk models. Further studies will be necessary to improve risk prediction models for CHD.