New Frontiers in Cardiovascular Risk Prediction

Recent key publications

Comparing Inflammatory Biomarkers in Cardiovascular Disease: Insights from the LURIC Study.
Int J Mol Sci 2025; 26 (15):7335. Moissl AP, Delgado GE, Scharnagl H et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40806466/

Elevated levels of inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA) and interleukin-6 (IL-6), are well recognised as predictors of cardiovascular risk. However, the value of assessing them together remains poorly understood. This knowledge gap is becoming increasingly important as researchers explore therapies that target specific inflammatory pathways, such as IL-6 inhibition. The current analysis from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study shows that the simultaneous presence of elevated levels of these markers identifies a distinct population of patients at high risk of mortality. These results emphasise the importance of each biomarker, particularly IL-6, and support the development of more sophisticated, multi-marker approaches to cardiovascular risk assessment.

Diagnostic accuracy of cardiovascular and imaging biomarkers to identify index patients with familial hypercholesterolaemia.
Curr Med Res Opin. 2025 Jul;41(7):1173-1183. Al Hasani W, Floyd CN, Walsh C et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40682427/

Accurately identifying index patients with monogenic familial hypercholesterolaemia poses a significant clinical challenge, particularly within large-scale screening programmes that identify numerous individuals with polygenic hypercholesterolaemia. This study assesses how cardiovascular and imaging biomarkers can improve diagnostic precision in a large real-world population. The results demonstrate that integrating a triglyceride-adjusted Dutch Lipid Clinic Network score alongside carotid plaque evaluation significantly enhances the efficacy of genetic testing. These findings provide a practical, evidence-based approach to improving the diagnosis of familial hypercholesterolemia amid growing demand for genetic testing resources.

Importance of Clinical, Laboratory, and Genetic Risk Factors for Incident CAD.
Circ Genom Precis Med. 2025 Aug;18(4):e004937. Bhattacharya R, Marnell CS, Cho SMJ et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40605734/

While traditional risk models attribute most cases of coronary artery disease to a small number of modifiable factors, modern risk assessment is increasingly incorporating genomic and biomarker data. This UK Biobank analysis examines, on a prospective basis, how clinical, laboratory and genetic risk factors – including polygenic risk scores, Lp(a) and hsCRP – contribute, both individually and collectively, to cardiovascular risk. The findings show that these contemporary factors are as important as hypertension and dyslipidaemia for predicting incident myocardial infarction. These results fundamentally change our understanding of residual cardiovascular risk, highlighting the critical need for comprehensive, integrated risk models in the era of precision prevention.

Evaluation of Lipoprotein(a) as a Prognostic Marker of Extracoronary Atherosclerotic Vascular Disease Progression.
Circulation. 2025 Sep 2;152(9):585-598. Bellomo TR, Bramel EE, Lee J et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40718930/

Despite significant progress in managing traditional risk factors, atherosclerotic vascular disease remains a leading cause of global morbidity, emphasising the importance of more effective risk stratification biomarkers. Lipoprotein(a) is a genetically determined risk factor with well-established links to coronary disease; however, its prognostic significance for peripheral and cerebrovascular disease is less clear. This large-scale, prospective UK Biobank study shows that high Lp(a) levels are strongly linked to the onset of peripheral artery disease and carotid stenosis, as well as to their progression to major adverse limb events and stroke. These findings establish Lp(a) as an important biomarker for identifying high-risk individuals across the entire arterial system, not just the coronary circulation.

Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease-A practical update for clinicians.
Diabetes Obes Metab. 2025 Sep;27 Suppl 8(Suppl 8):15-33. Beernink JM, van Mil D, Laverman GD et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40143452/

As the range of kidney-protective therapies expands, from SGLT2 inhibitors to non-steroidal mineralocorticoid receptor antagonists, the precise role of albuminuria in modern clinical practice deserves renewed attention. Long established as a marker of glomerular injury, albuminuria has emerged as a crucial biomarker for assessing cardiovascular risk and as an indicator of how patients respond to treatment. Its incorporation into the 2024 KDIGO guidelines and its use in predicting absolute benefit from novel therapies is recent evidence that highlights its prognostic value, independent of traditional risk factors. This comprehensive review summarises the latest advances in albuminuria testing, from the underlying mechanisms to clinical applications, and provides clinicians with a vital update to help them optimise patient care in the era of precision therapeutics.

Association between neutrophil-lymphocyte ratio levels and mortality related to cardiovascular cause and all causes in coronary artery disease patients with low-density lipoprotein cholesterol below 1.4 mmol/L: A multicenter cohort study.
Nutr Metab Cardiovasc Dis. 2025 Sep;35(9):104058. Jiang R, Ruan H, Zhang W et al.

Link to full article: https://pubmed.ncbi.nlm.nih.gov/40268567/

Despite achieving the recommended low-density lipoprotein cholesterol level of below 1.4 mmol/L, patients with coronary artery disease still have a substantial residual cardiovascular risk, which intensifies the search for modifiable risk factors beyond lipids. Systemic inflammation has emerged as a key contributor to this residual risk; however, a practical biomarker for routine clinical use is lacking. This multicentre cohort study examines the prognostic value of the neutrophil-to-lymphocyte ratio – a readily accessible haematological inflammatory marker – in a real-world population of 2,749 patients with well-controlled LDL-C. The results demonstrate that an elevated NLR independently predicts a significantly higher risk of long-term cardiovascular and all-cause mortality, highlighting its potential in refining risk stratification and identifying patients who could benefit from more aggressive anti-inflammatory therapies.