Circulating biomarkers with preventive, diagnostic and prognostic implications in cardiovascular diseases.

The search for molecules that may contribute to better identify patients at risk for cardiovascular diseases (CVD) represents today an active field in clinical research. Few biomarkers have already been identified as reliable and useful tools in medical decision making, such as cardiac troponin (cTn) and NT-proBNP. At the same time, evidence regarding the possible role of other molecules is piling up. Every new putative biomarker has demonstrated effectiveness in at least one clinical application: cardiovascular risk assessment, diagnosis or outcome prediction. On the other hand, combination of preventive, diagnostic and prognostic implications for the same molecule is expected to improve enormously the usefulness of a biomarker in medicine. We performed a search of the literature looking for circulating molecules found to exert discriminating abilities in all three mentioned clinical applications. The purpose of the present review is to bring to the attention of medical and research communities those biomarkers for which a relevant amount of evidence has been accumulated regarding their potential application in all clinical steps of the cardiovascular continuum. Furthermore, since simultaneous testing of different plasmatic molecules has been proposed as a suitable tool to improve medical decision making, we also discuss feasible associations of biomarkers that promise to be the most effective for cardiovascular risk assessment in the general population and for outcome prediction in patients affected by acute coronary syndrome (ACS) and by heart failure (HF).