Update on selected markers used in risk assessment for vascular disease.

1. Eileen Carreiro-Lewandowski, MS CLS(NCA)[⇑][1] 1. is a Professor at the University of Massachusetts Dartmouth, N Dartmouth MA 1. Address for correspondence: Eileen Carreiro-Lewandowski MS CLS(NCA), University of Massachusetts Dartmouth, Department of Medical Laboratory Science, 285 Old Westport Rd, N Dartmouth, MA 02747-2300. (508) 999-8213, (508) 999-8418 (fax). ecarreiro{at}umassd.edu 1. Define endothelium dysfunction. 2. Describe the interrelationship of endothelium dysfunction and CVD. 3. Discuss the LDL, total cholesterol, HDL, and triglyceride levels recommended in the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) guidelines. 4. Describe the major risk factors, exclusive of LDL levels and existing CHD, that may modify LDL therapeutic goals. 5. List the conditions defining the metabolic syndrome. 6. List the guidelines for lipoprotein testing. 7. Discuss the apparent relationship of omega-3 fatty acid levels and sudden death. 8. Compare and contrast the terms “risk factor” and “risk marker”. 9. List the key factors that influence the predictive value and clinical utility of blood test markers. 10. Discuss the use of hs-CRP as an indicator of CHD. 11. List several inflammatory markers, excluding hs-CRP, that may be used to indicate possible risk of CVD. 12. Discuss some of the recent findings in non-inflammatory CVD testing. INTRODUCTION The current Focus section includes three articles associated with updates on various cardiac markers. The initial article, entitled, “Update on Selected Markers Used in Risk Assessment for Vascular Disease” by Eileen Carreiro-Lewandowski, provides information on selected markers used in preventative medicine for identifying and establishing treatment plans for patients at increased risk of vascular disease. Alan Wu, from Hartford Hospital, CT and a well-known authority in cardiac marker utilization, authors the second article providing essential information on troponin assay issues. The last article, written by Debra Faubion, provides information regarding BNP testing. Vascular disease, including that leading to heart disease, stroke, or other thrombotic related disorders, continues to plague the public at alarming rates. The estimated annual costs of cardiovascular disease in the USA and Canada are $298 billion and $20 billion, respectively.1 More recently, atherosclerosis development and progression have been strongly linked to inflammatory processes. The term “cardiovascular vascular disease” (CVD) often represents a myriad of symptoms affecting multiple vascular territories including major arteries associated with the heart and brain, and most likely other organs such as the kidneys, plus the peripheral circulation.2 It is estimated that transient ischemic attacks, whether cardiac, cerebrovascular, renal, or vascular, have not been included in many major studies, and the real incidence of vascular disease is much higher than reported. A constellation of lipid and nonlipid risk factors, including those referred to as the ‘metabolic syndrome’, clearly links development of diabetes mellitus and CVD. One of the risk factors, obesity, has reached… ABBREVIATIONS: ATPIII = Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III); CHD = coronary heart disease; CVD = cardiovascular vascular disease; ET-1 = Endothelin 1; HDL = high density lipoprotein cholesterol; HRT = hormone replacement therapy; Hs-CRP = high-sensitivity C-reactive protein; LDL = low density lipoprotein cholesterol; NO = nitric oxide; PAF = potent platelet-activating factor; TG = triglycerides; TLC = therapeutic lifestyle changes. 1. Define endothelium dysfunction. 2. Describe the interrelationship of endothelium dysfunction and CVD. 3. Discuss the LDL, total cholesterol, HDL, and triglyceride levels recommended in the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) guidelines. 4. Describe the major risk factors, exclusive of LDL levels and existing CHD, that may modify LDL therapeutic goals. 5. List the conditions defining the metabolic syndrome. 6. List the guidelines for lipoprotein testing. 7. Discuss the apparent relationship of omega-3 fatty acid levels and sudden death. 8. Compare and contrast the terms “risk factor” and “risk marker”. 9. List the key factors that influence the predictive value and clinical utility of blood test markers. 10. Discuss the use of hs-CRP as an indicator of CHD. 11. List several inflammatory markers, excluding hs-CRP, that may be used to indicate possible risk of CVD. 12. Discuss some of the recent findings in non-inflammatory CVD testing. [1]: #corresp-1