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Emerging CV Risk Factors

The National Academy of Clinical Biochemistry

Laboratory Medicine Practice Guidelines

Emerging Biomarkers for Primary Prevention of Cardiovascular Disease and Stroke 

Publication Date: 2009

Chinese Translation

Heart disease and stroke continue to be the leading causes of death in the United States. As a result, investigators continue to look for new and emerging biomarkers of disease risk. Because many of these emerging biomarkers are not as well documented as those of conventional lipid and lipoprotein risk factors, their value in clinical practice needs to be critically appraised and appropriate guidelines developed for their proposed use.

The National Academy of Clinical Biochemistry (NACB) convened a multidisciplinary expert panel to develop laboratory medicine practice guidelines for a selected subset of these emerging risk factors as applied in a primary prevention setting of heart disease and stroke. The NACB expert panel selected lipoprotein subclasses and particle concentration, lipoprotein(a), apolipoproteins A-I and B, high sensitivity C-reactive protein (hsCRP), fibrinogen, white blood cell count, homocysteine, B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and markers of renal function as biomarkers that fell within the scope of these guidelines.

Based on a thorough review of the published literature, only hsCRP met all of the stated criteria required for acceptance as a biomarker for risk assessment in primary prevention.

The purpose of this document is to discuss utilization of emerging laboratory biomarkers of cardiovascular and stroke risk in a primary prevention setting. The NACB is the scientific academy of the AACC. An important activity of the NACB is to develop laboratory medicine practice guidelines to assist clinical and laboratory practice decisions concerning patients at increased risk for specific diseases.

This LMPG was presented at the Arnold O. Beckman Conference, Baltimore, MD, October 2006.

Guidelines Committee:

  • Gary L. Myers, PhD, Chair, Centers for Disease Control and Prevention, Atlanta, GA
  • Robert H. Christenson, PhD, Vice-Chair, University of Maryland School of Medicine, Baltimore, MD
  • Mary Cushman, MD, MSc, University of Vermont, Colchester, VT
  • Christie M. Ballantyne, MD, Baylor College of Medicine, Houston, TX
  • Gerald R. Cooper, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA
  • Christine M. Pfeiffer, PhD, Centers for Disease Control and Prevention, Atlanta, GA
  • Scott M. Grundy, MD, University of Texas Southwestern Medical Center, Dallas, Texas
  • Darwin R. Labarthe, MD, MPH, PhD, Centers for Disease Control and Prevention, Atlanta, GA
  • Daniel Levy, MD, Framingham Heart Study, Framingham, MA
  • Nader Rifai, PhD, Children's Hospital and Harvard Medical School, Boston, MA
  • Peter W. F. Wilson, MD, Emory University School of Medicine, Atlanta, GA
This LMPG was developed by an independent committee of the NACB. Subsequent publication of these guidelines has been supported by the Academy.