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In recent years, numerous new biomarkers have been proposed for risk stratification in coronary heart disease (CHD), as opportunistic researchers have capitalized on stored blood samples from large clinical trials and registries to perform rapid and relatively inexpensive biomarker screening. A number of biomarkers reflecting distinct pathophysiological processes, including C-reactive protein (CRP), B-type natriuretic peptide (BNP), and markers of renal function such as creatinine clearance (CrCl) and cystatin C, have been shown to provide independent prognostic value to traditional risk predictors in multivariable analyses. While the demonstrations of such associations are necessary first steps, they do not establish the full clinical utility of a biomarker, which is a more demanding process that requires validation in multiple cohorts, a reliable and cost-effective assay, and clear demonstration of incremental prognostic value over traditional risk models. An important but often overlooked consideration is that the biomarker must offer tangible value to the end users (the clinician and the patient) in order to be widely adopted. This is best accomplished by either improving diagnostic performance or providing therapeutic guidance. It is also possible that more accurate risk stratification may help to convince patients to comply with lifestyle recommendations and preventive therapies, although this has yet to be proven. Examples of biomarkers that have been widely adopted and largely meet the needs of clinicians and their patients include troponin testing for the diagnosis of myocardial infarction and low-density lipoprotein cholesterol measurement to guide lipid management.
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