Description of Treatment/Procedure

Atherosclerosis is now recognized as an inflammatory disease. Endothelial dysfunction, potentially caused by one or a combination of factors, is the first step. A lipid profile is the accepted method of assessing an individual's risk for coronary heart disease (CHD). However, traditional risk factors (tobacco use, age, gender, family history, hypertension, diabetes, and lipid levels) do not identify all patients who will experience a cardiovascular event. Biochemical markers of the steps leading to the development of atherosclerotic lesions may complement the traditional risk factor profile. These would include markers of lipoprotein metabolism (lipoprotein (a)), endothelial dysfunction (homocysteine), fibrinolysis (plasminogen activation inhibitor 1), and inflammation (C-reactive protein).

Committee Summary

With regard to biochemical markers of cardiovascular disease risk, the ICSI Technology Assessment Committee finds:

1. The basic lipid profile (high-density lipoprotein, low-density lipoprotein, and triglycerides) provides a useful indication of cardiovascular disease risk and serves as a guide for statin therapy in a primary prevention context.
   
2. CRP, if measured by high-sensitivity assay (hs-CRP), may have independent value as a predictor of cardiovascular disease risk and independent value in identifying patients with normal lipids who could benefit from treatment (Conclusion Grade II). hs-CRP elevations can be caused by inflammatory conditions and, therefore, are not specific for cardiovascular assessment in individual patients. Further study is needed to determine if decreasing CRP levels would decrease cardiovascular disease risk.
   
3. The relevance of studies of tHcy as a risk factor for cardiovascular disease is unclear given the decreasing tHcy levels as a result of mandatory folic acid supplementation. It remains unproven whether lowered tHcy levels will result in reduced morbidity and mortality from cardiovascular disease.
   
4. Other biochemical markers do not add to the prediction of risk above that achieved using lipid measures and hs-CRP.
   
5. Assessment of the markers is safe, requiring only a blood sample for analysis.