Cardiovascular disease continues to be the leading cause of mortality in the US

By Ken
June 22, 2021
Uncategorized

Knowledge of an inflammatory biomarker of cardiovascular risk leads to biomarker-based decreased risk in pre-diabetic and diabetic patients

Cardiovascular disease continues to be the leading cause of mortality in the US, where nearly one-third of deaths can be directly attributed to a cardiovascular event. The growing increase in the prevalence of pre-diabetes and diabetes has changed the underlying risk profile of cardiovascular disease from one focused on cholesterol levels to one of vascular inflammation. Diabetes is a risk equivalent for cardiovascular disease because diabetics without a history of acute myocardial infarction (AMI) have the same likelihood of an AMI as non-diabetic patients with a history of AMI. Diabetes has been linked to an increased drive of vascular inflammation through multiple mechanisms including lipid oxidation, advanced glycation end-products and increased insulin levels.

Assessing risk factors of cardiovascular disease and screening for coronary artery disease (CAD) and its equivalents like diabetes have been the goal of the American College of Cardiology and the American Heart Association. They have tried to implement simple and evidence-based guidelines with high-sensitivity screening at a relatively low cost. After withdrawing the target goal for low-density lipoprotein (LDL) treatment in the new guidelines, it remains uncertain how successful we really are at controlling patients at risk and who would require further treatment and more aggressive strategies. This is important in light of recent data showing that approximately 50% of patients admitted with CAD and acute ischemic events have acceptable cholesterol levels.¹

The link between atherosclerosis, clinical events and inflammation has been recognized for years and is well established.² The recent findings of the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) validated the concept that targeting inflammation is a good strategy to prevent clinical events in patients with atherosclerosis.³ There is growing recognition of the physiology represented by the measurement of novel markers of oxidation and inflammation.⁴ Two markers, lipoprotein-associated phospholipase A2 (Lp-PLA2) and myeloperoxidase (MPO)), are markers of vulnerable plaque and risk of clinical events.^2,5–7 Although it is unclear that the inhibition of either of these enzymes would have clinical benefit,^8,9 increased circulating levels of these markers are linked to increased risk of stroke and AMI.

In this study, we assessed whether the addition of a marker of vascular inflammation to advanced cholesterol measures annually in a primary-care population would lead to the long-term, down-regulation of cardiovascular risk. In recognition of the changing landscape of cardiovascular risk assessment, MD Value In Prevention (MDVIP) added MPO to their annual wellness panel in 2011. In this study, we present the findings of >100,000 patients who had these wellness panels yearly. Our objectives were to examine whether knowledge of vascular inflammation altered cardiovascular risk over time, and how knowledge of vascular inflammation changed the cardiovascular risk of non-diabetic, pre-diabetic and diabetic patients.