title: The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society.
abstract: While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further stratify the risk of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for a clinical endpoint. In order to be considered as a surrogate endpoint of cardiovascular events, a biomarker should satisfy several criteria, such as proof of concept, prospective validation, incremental value, clinical utility, clinical outcomes, cost-effectiveness, ease of use, methodological consensus, and reference values. We scrutinized the role of peripheral (i.e. not related to coronary circulation) noninvasive vascular biomarkers for primary and secondary cardiovascular disease prevention. Most of the biomarkers examined fit within the concept of early vascular aging. Biomarkers that fulfill most of the criteria and, therefore, are close to being considered a clinical surrogate endpoint are carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity; biomarkers that fulfill some, but not all of the criteria are brachial ankle pulse wave velocity, central haemodynamics/wave reflections and C-reactive protein; biomarkers that do no not at present fulfill essential criteria are flow-mediated dilation, endothelial peripheral arterial tonometry, oxidized LDL and dysfunctional HDL. Nevertheless, it is still unclear whether a specific vascular biomarker is overly superior. A prospective study in which all vascular biomarkers are measured is still lacking. In selected cases, the combined assessment of more than one biomarker may be required.
authors.affiliation: Peripheral Vessels Unit, 1st Department of Cardiology, Athens University Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.affiliation: Peripheral Vessels Unit, 1st Department of Cardiology, Athens University Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Xaplanteris
authors.affiliation: Department of Cardiology, Dupuytren University Hospital, Limoges, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
authors.affiliation: Department of Angiology, University Hospital Graz, 8036 Graz, Austria.
authors.forename: Marianne
authors.initials: M
authors.lastname: Brodmann
authors.affiliation: Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Renata
authors.initials: R
authors.lastname: Cífková
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cosentino
authors.affiliation: Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Ospedale Cisanello, 56124 Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.affiliation: Division of Vascular Medicine, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
authors.forename: Augusto
authors.initials: A
authors.lastname: Gallino
authors.affiliation: Department of Cardiology, Charité - Universitätsmedizin Berlin (CBF), 12203 Berlin, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Service de Pharmacologie and INSERM U 970, Université Paris-Descartes, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Laurent
authors.affiliation: 2(nd) Department of Cardiology, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.affiliation: Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, United Kingdom.
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.affiliation: 2(nd) Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece.
authors.forename: Katerina K
authors.initials: KK
authors.lastname: Naka
authors.affiliation: Hypertension Unit & Cardiovascular Research Laboratory, 1st Department of Internal & Propedeutic Medicine, Laiko General Hospital, National & Kapodistrian University of Athens, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Protogerou
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Rizzoni
authors.affiliation: Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, 4052 Basel, Switzerland.
authors.forename: Arno
authors.initials: A
authors.lastname: Schmidt-Trucksäss
authors.affiliation: Heymans Institute of Pharmacology, Ghent University, 9000 Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.affiliation: Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
authors.affiliation: Department of Cardiology, Tokyo Medical University, 160-0023 Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
authors.affiliation: Department of Medicine and Hypertension Institute, Brunner Institute for Cardiovascular Research, Sackler Faculty of Medicine, Tel-Aviv University, The E. Wolfson Medical Center, Holon 58100, Israel.
authors.forename: Reuven
authors.initials: R
authors.lastname: Zimlichman
authors.affiliation: Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris 75015, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.affiliation: Department of Cardiology, Wales Heart Research Institute, Cardiff CF14 4XN, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Cockcroft
authors.affiliation: St Vincent's Clinic, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Rourke
authors.affiliation: Department of Medicine/Cardiology, Cheil General Hospital, Dankook University College of Medicine, Seoul 100-380, Republic of Korea.
authors.forename: Jeong Bae
authors.initials: JB
authors.lastname: Park
authors.affiliation: Unit of Internal Medicine, Department of Medicine, University of Perugia and Terni University Hospital, Terni, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.affiliation: Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sillesen
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, United States.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
mesh_terms: D000375:Aging; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002309:Cardiology / Q000592:standards*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005060:Europe; D006439:Hemodynamics; D006801:Humans; D011322:Primary Prevention; D012107:Research Design; D012306:Risk; D055502:Secondary Prevention; D012955:Societies, Medical; D016896:Treatment Outcome; D014463:Ultrasonography; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Ankle-brachial index; Arterial stiffness; Carotid ultrasonography; Central haemodynamics; Circulating biomarkers; Endothelial function; Vascular biomarkers; Wave reflections