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el conocimiento previo para estos factores independientes de riesgo cardiovascular;

Oxido Nitrico, Radicales Libres, Homocisteina, fibrinógeno, Lipoproteina (a) y la

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The Global Epidemic of Cardiovascular Disease – Diagnostic Standards

and the Role of the Clinical Laboratory in Primary and Secondary Prevention

and Risk Stratification

Professor M. J. McQueen

There is a global epidemic of atherosclerosis and the future disease burden is probably

underestimated because projections do not account for potential increases in risk factors

such as obesity, diabetes, dyslipidemia, hypertension, smoking, and urbanization.

Population based studies now suggest that 80% to 90% of CVD susceptibility can be

explained by a relatively small number of “classical” risk factors. However, myocardial

infarction occurs in up to 50% of people without significant lipid abnormalities and this

has led to the investigation of novel risk factors such as lipoprotein( ApoA1, ApoB,

homocysteine, inflammatory markers, infectious markers, and oxidative stress factors.

The clinical laboratory has a significant role in diagnosis, risk stratification, management

and prognosis in acute coronary syndromes, as well as the primary and secondary

prevention of cardiovascular disease.

Myocardial infarction has been re-defined, giving primacy to the rise and fall of

biochemical markers of myocardial necrosis (troponin/CK-MB) accompanied by at least

one of several symptoms and signs. This has created analytical issues for the clinical

laboratory. The biochemical markers may be cardio-specific but there is still not one

which is ischemic heart disease specific, so various markers for myocardial ischemia

have been investigated. Inflammatory markers have been shown to have prognostic

value in identifying those patients with acute coronary syndrome who are at greater risk

of death or myocardial infarction.

For primary and secondary prevention of cardiovascular disease, lipids and lipoproteins,

LP(a), homocysteine, and many inflammatory markers such as oxidized LDL, IL1,

TNF-α, ICAM, VCAM, selectins, IL6, SAA, and CRP have all been investigated. The

evidence for hsCRP as a risk marker for subsequent cardiovascular events is more clearly

demonstrated in primary prevention than secondary prevention cohorts. Data will be

presented from our Heart Outcomes Prevention Evaluation (HOPE) study relating to

inflammatory markers, multiple infection, heat shock proteins and their relative risk for

subsequent cardiovascular events. There is a need for more research to further define the

approach to therapeutic decision making, using markers of inflammation, infection, and

ventricular dysfunction (eg, natriuretic peptides). File:shd.CV abstract