Update on Selected Markers Used in Risk Assessment for Vascular Disease

Clinical Laboratory Science, Winter 2004 by Carreiro-Lewandowski, Eileen

The differences between males and females in assessing CVD risk remains a mystery. Studies regarding HRT as a means of decreased incidence of CVD have yielded conflicting results. Reduced iron stores associated with menstruation has been given some consideration. The idea that iron overload may contribute to increased CVD due to the formation of oxidized free radicals, has been refuted using angiography and measurements of ferritin, yet more recent animal studies indicate that a "moderate iron loading markedly accelerates thrombus formation after arterial injury, increases vascular oxidative stress, and impairs vasoreactivity".28,29 Much of the risk assessment data to date is based on predominantly male populations. Questions arise regarding the effectiveness of the current risk assessment markers in pre- and post-menopausal female populations. Do real differences between the sexes exist or does research need to focus on a different set of indicators for this population?

SUMMARY

CVD remains the greatest health risk in the U.S.. Assessment of laboratory data in establishing risk and treatment modalities has come to the forefront in patient primary care. Guidelines published in the ATP III document by the NCEP have incorporated lower limits of lipids and included a number of risk factors and conditions, such as the metabolic syndrome associated with insulin-resistance, as a means for earlier detection and intervention in CVD. Endothelial dysfunction and the associated inflammatory process, including soluble plasma markers, have lead to the addition of hs-CRP as an adjunct to other laboratory indicators of CVD. The precise mechanisms and interrelationships between these factors and atherosclerosis have yielded some confusing data, along with investigations of a number of associated substances and conditions. An emerging theme is the body's response to injury and stress; a lack of metabolic balance. While currently outside the domain of routine laboratory testing, future CVD risk assessment may include the metabolic by-products generated by chronic external pressures, including genetic predisposition or alterations associated with socioeconomic factors. Further studies are needed to better understand the significance each plays in assessing the individual's development and CVD risk.

REFERENCES

1. American Heart Association (2002), Heart and stroke statistical update, American Heart Association: Washington DC.

2. Fritsma G. Laboratory results that predict arterial thrombosis. Clin Lab Sci 2001;14(4):262-8.

3. Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circ 2000; 101:1899-906.

4. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). NIH Publication-01-3670, May, 2001. www.nhlbi.nih.gov/guidelines/cholesterol/. Accessed June 15, 2003.