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Progress towards identifying biomarkers of vascular aging for total cardiovascular risk prediction

Vlachopoulos, Charalambos

doi: 10.1097/HJH.0b013e328353e534
Original Articles

Although several scoring systems for cardiovascular risk prediction are valuable in the assessment and management of asymptomatic individuals and patients, differences between predicted and actual events do exist. The concept of vascular aging as a cumulative measure of the impact of cardiovascular risk factors on the arterial wall has the potential to gauge an individual's overall cardiovascular risk. In this context, candidate arterial biomarkers, apart from proving an incremental predictive value over and above traditional risk factors, must fulfill stringent criteria in order to be integrated into clinical practice; these include calibration, discrimination and reclassification. Current evidence suggests that arterial stiffness fulfills the criteria for a biomarker of vascular aging, whereas central hemodynamics and carotid intima–media thickness are close. Endothelial function, although a valuable research tool, has shortcomings in terms of risk prediction, largely dependent on the methodological approach, which may make it less desirable as a biomarker.

Peripheral Vessels Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece

Correspondence to Charalambos Vlachopoulos, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Profiti Elia 24, Athens 14575, Greece. E-mail:

Abbreviations: AHA, American Heart Association; AIx, augmentation index; BP, blood pressure; CAFE, Conduit Artery Function Evaluation; cf-PWV, carotid-femoral PWV; CHD, coronary heart disease; cIMT, carotid intima-media thickness; CVD, cardiovascular disease; ELSA, European Lacidipine Study on Atherosclerosis; FATE, Firefighters And Their Endothelium; FMD, flow-mediated dilation; MI, myocardial infarction; NRI, net reclassification improvement; PP, pulse pressure; PWV, pulse wave velocity; SCORE, Systemic Coronary Risk Evaluation; UACR, urine albumin/creatinine ratio

Received 20 March, 2012

Accepted 20 March, 2012

© 2012 Lippincott Williams & Wilkins, Inc.