Authors: Miller, Virginia M.; Redfield, Margaret M.; McConnell, Joseph P.

Source: Current Vascular Pharmacology, Volume 5, Number 1, January 2007 , pp. 15-25(11)

Publisher: Bentham Science Publishers

Abstract:

Biomarkers are used in medicine to facilitate diagnosis, assess risk, direct therapy and determine efficacy of treatment. Sensitivity and specificity are essential in order for a biomarker to be useful. Brain natriuretic peptide (BNP) and C-reactive protein (CRP) are considered biomarkers of cardiovascular disease. However, they differ in function, sensitivity and specificity. BNP is released from the myocardium in response to myocardial stretch, a clear cause and effect relationship; therefore, it is useful in the diagnosis of heart failure when patients present with dyspnea of unknown origin and to assess treatment in high risk patients with diagnosed heart failure. Sex and age based reference ranges and partition values are established from clinical trials and from populations screened for the absence of cardiovascular disease. Highly sensitive and reproducible methods are also available to measure CRP. However, although CRP is associated with adverse cardiovascular events, unlike BNP, multiple stimuli increase production of CRP. Therefore, elevation in CRP is not specific to cardiovascular disease. Partition values for CRP and cardiovascular risk based on epidemiological studies predict risk for populations but may not always be useful when used alone to predict individual risk or to direct therapy. Given the non-specific stimuli which affect circulating concentrations of CRP, using CRP to monitor treatment to reduce cardiovascular risk may provide little benefit without understanding or targeting the underlying causes for its elevation.

Keywords: B-type natriuretic peptide; BNP; coronary artery disease; C-reactive protein; CRP; estrogen; heart failure; hormone replacement therapy

Document Type: Research article

Affiliations: 1: Medical Science Building 4-62, Mayo Clinic Rochester, 200 First Street, SW, Rochester, MN 55905,USA.

Publication date: 2007-01-01

More about this publication?

• Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials.
  
  Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units). Current Vascular Pharmacology will publish reviews to update all those concerned with the treatment of vascular disease. For example, reviews commenting on recently published trials or new drugs will be included. In addition to clinically relevant topics we will consider 'research-based' reviews dealing with future developments and potential drug targets. Therefore, another function of Current Vascular Pharmacology is to bridge the gap between clinical practice and ongoing research.
  
  Debates will also be encouraged in the correspondence section of this journal.

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