Predicting the risk of a heart attack and treating it through drugs and lifestyle changes could be a real lifesaver, cutting distress for individuals and their families and cutting costs to society and healthcare providers. Current biomarkers used to predict risk include total cholesterol and high-density lipoprotein cholesterol (HDL-C), but adding in extra lipid biomarkers only slightly improves the predictive value, according to a study published in The Journal of the American Medical Association.
The researchers, from the Emerging Risk Factors Collaboration, looked at levels of apolipoprotein B, apolipoprotein A-I, lipoprotein(a), and lipoprotein-associated phospholipase A2 in the records of 165,544 people without cardiovascular disease to see if they could improve prediction. These people were recruited to studies in 1968-2007 and followed up for a median of 10 years.
Looking at the outcomes, it seems that adding in these extra biomarkers only slightly improved the chance of predicting cardiovascular disease, and using them instead of total cholesterol and HDL actually reduced the chance of predicting risk.
In an editorial, published in the same issue of JAMA, Scott Grundy of the University of Texas Southwestern Medical Center suggests that: "A lack of association between apolipoprotein B and improvement in predictive power … may relate to the limitations of measurement of the molecule." He adds: "More promising approaches for the future risk assessment may be either testing for early, subclinical atherosclerosis by imaging methods or by simple, qualitative risk projection based on age, sex, low-density lipoprotein levels, and perhaps another major risk factor."