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Risk assessment in cardiovascular disease: from traditional risk factors to genomics

V. Dzau*

Department of Medicine, Brigham Women's Hospital, Boston, Massachusetts, U.S.A.

* Victor Dzau, MD, Department of Medicine, Brigham Women's Hospital, 75 Francis Street, Tower 1 Room 210, Boston, MA 02115, U.S.A.

Abstract

In addition to the traditional Framingham risk factors, candidate markers for cardiovascular disease are being proposed and their number continues to grow. High-sensitivity C-reactive protein has been validated as a risk factor for both primary and secondary cardiovascular events. Most other protein markers, however, remain incompletely validated. Molecular analysis of the genetic loci associated with monogenic disorders may help to identify polymorphisms that underlie major polygenic disorders, such as essential hypertension. Genomics and proteomics have accelerated the discovery of novel genes, gene expression patterns, proteins and single nucleotide polymorphisms as predictors of disease outcome and drug response, but their validation and characterization in clinical studies remain a challenge. Studies such as The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) Trial Programme are addressing this issue by collecting large numbers of samples for mass pharmacogenomic analysis. In conclusion, novel disease markers and risk factors promise to have a radical impact on cardiovascular medicine in the long term, but their adoption into clinical practice is dependent on widespread validation in patient populations, ease of measurement and extensive physician education.

Key Words: Biomarkers • Cardiovascular disease • Genomics • Pharmacogenomics • Risk factors


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