Key result
B type natriuretic peptide is the most powerful predictor of cardiovascular mortality in angina, while ischaemia modified albumin is promising for early detection of ischaemia.
Biomarkers such as BNP and ischaemia modified albumin are highlighted for their utility in predicting cardiovascular mortality and early detection of ischaemia in the continuum of atherothrombotic disease.
Supports cautious biomarker use in angina; leaves open prospective validation before practice change.
Angina represents the earliest stage of symptomatic atherothrombotic disease and is part of the continuum that ultimately results in myocardial infarction. Development of plaque is related to conventional risk factors. The progression to active disease occurs as a result of plaque destabilisation and rupture. This is a continuous process with clinically apparent disease occurring when there are multiple episodes of plaque rupture. Elevation of inflammatory markers including C reactive protein is predictive of the risk of development of cardiac events. However, it appears that B type natriuretic peptide is single most powerful predictor of cardiovascular mortality. This probably reflects its role as the integrator of the cardiac neuroendocrine system and marker of global cardiac performance. Progression of disease to occlusion will initially produce myocardial ischaemia, which may then progress to infarction. Ischaemia modified albumin is currently the most promising of the markers for early detection of ischaemia at first presentation.
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Paul Collinson (2005) conducted a review in Angina. Biomarkers (CRP, BNP, Ischaemia modified albumin) was evaluated. B type natriuretic peptide is the most powerful predictor of cardiovascular mortality in angina, while ischaemia modified albumin is promising for early detection of ischaemia.
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