Cardiac Biomarkers

A blood screening technology has uncovered many biomarkers that improve the prediction of the risk for heart attack or stroke with in the next 15 years. The blood profiling technique may eventually help doctors to identify those people who would benefit the most from early treatment and high-throughput profiling of circulating metabolites may improve cardiovascular risk prediction over established rik prediction over established risk factors. 

Biomarkers can potentially be used to detect and monitor a wide range of cardiac conditions in the critical care setting. Currently the only biomarker acceptable for changing management in acute coronary syndrome is the troponin test. In the future, a tailored multi-marker approach may have use in guiding diagnosis and therapy – this is a long way off!

POTENTIAL USES OF CARDIAC BIOMARKERS

Myocardial Ischemia

·         Troponin

·         H-FABP

·         ischaemic modified albumin

Thrombosis

·         CRP

·         ESR

·         different binding proteins

·         Myocardial injury

·         Troponin (level peaks at 12h, proportional to infarct size, but altered by washout phenomenom after reperfusion therapy)

·         CK

·         CK-MB

·         myoglobin

·         AST

·         LDH

Novel: copeptin (C-terminal provasopressin), BNP/ NTproBNP, GP-BB, myleoperoxidase, pregnancy associated plasma protein A

Inflammation, endothelial activation and neutrophilic activation

·         CRP

·         ESR

·         PaPPA

·         endothelin/ CTproET-1

·         adrenomedullin/ MRproADM

·         myeloperoxidase

·         matrix metalloproteinases (MMP9, MMP2, TIMP1)

Heart failure

·         BNP/ NTproBNP

·         ANP/ N-ANP/ MRproANP

·         Troponin

·         IL18

·         CA125

·         Urocortin

Sepsis-induced myocardial dysfunction

·         Troponin

·         BNP/ NTproBNP

·         Right ventricular strain in pulmonary embolism

·         Troponin

·         BNP/ NTproBNP

ADVANTAGES AND DISADVANTAGES 

In addition these biomarkers mentioned above four new biomarkers were identified in 2015. The scientists identified over 200 biomarkers for body metabolism from a single blood sample using Nuclear Magnetic Resonance (NMR) spectroscopy. The perspectives of new biomarkers for future cardiovascular disease were Phenylalanine, a common amino acid, and the amount of monounsaturated fat in the blood; higher concentrations were linked with higher disease risk. These two biomarkers were as strong predictors of future heart disease as the measures bad cholesterol or blood pressure. In addition, higher blood levels of both omega-3 and omega-6 fatty acids were linked with lower risk for cardiovascular disease. All these molecules are normally present in everyone's blood, but it is the amount of these molecules that was shown to be reflecting the cardiovascular health. 

These new biomarkers can help to better assess the complex molecular processes behind the development of cardiovascular disease. The improved prediction of cardiovascular risk also suggests cost saving in healthcare by advanced biomarker profiling. The low-cost blood screening technology opens a treasure trove to understand the molecular mechanism of heart disease and other metabolic disease.

by 

Dr.Akshaya Srikanth Bhagavathula, Pharm.D 

for Pharm.D India