Novel antecedent plasma biomarkers of cardiovascular disease: improved evaluation methods and comparator benchmarks raise the bar

Purpose of review To assess recent advances in cardiovascular disease biomarkers, focusing on past failings, current promise, and areas for future work. Recent findings Despite intense interest in novel biomarkers, few have yet to show utility in improving cardiovascular disease risk scores as assessed by predictive statistical models. Indeed, there is current debate as to how to evaluate clinical utility. There is increasing interest in biomarkers from pathophysiological pathways other than inflammation (cardiac signals, renal function, metabolic measures, novel lipids, nutritional, etc), as well as interest in combining such markers in panels to increase cardiovascular disease risk discrimination, and in 'omics' techniques. A challenge to the biomarker concept in cardiovascular disease is the contribution of other factors-for example, socioeconomic position or family history of premature cardiovascular disease-that present cheaper and more efficient way of gaining discrimination. Some have been added already to risk score guidelines in some countries. Whether novel plasma biomarkers can add further prediction requires study. Summary The jury is still out on the ability of biomarkers to enhance risk scores in a cost-efficient way. New technologies and statistical models may optimize efforts but use of simpler lifestyle and demographic markers in recent risk scores revisions have raised the bar.