2.2 Risk prediction

A developing atherosclerosis is an underlying cause of CVD and it is well accepted that inflammation is implicated in the pathogenesis. Atherosclerosis develops gradually over many years and is already advanced and irreversible by the time of any tangible symptoms. Myocardial infarction (MI) and stroke often occur suddenly and before medical assistance is available. Hence, reliable biomarkers of a developing atherosclerosis are of great importance.

Serum level of low-density lipoprotein (LDL) cholesterol is an important factor in the development of atherosclerosis, and still remains the primary target of therapy for the prevention of coronary heart disease (CHD). However, elevated serum level of LDL-cholesterol, even together with other risk factors, is a poor predictor of a future CHD event. CHD risk functions like Framingham (score includes gender, age, total cholesterol, HDL-cholesterol, cigarette smoking, blood pressure and diabetes) and PROCAM (score includes gender, age, cigarette smoking, blood pressure, history of diabetes, blood levels of LDL-cholesterol, HDL-cholesterol, sugar and triglycerides and heart attack history) seem to over or under estimate the risk of future CHD events in several populations. This imprecise estimation results in both over and under treatment. Sharper tools are indeed needed for risk assessment of CHD and biomarkers like myeloperoxidase (MPO), lipoprotein(a) (Lp(a)) and oxidized low-density lipoprotein (oxLDL) may prove to be useful complements to currently used risk scores.

A Relationship Between LDL-Cholesterol and Coronary Artery Disease

B Relationship Between Oxidized LDL and Coronary Artery Disease

Figures. When dividing blood levels of LDL cholesterol (A) and oxLDL (B) into quintiles, oxLDL correlates much stronger than LDL-cholesterol to the percentage of patients with CAD in each quintile.

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