Cardiovascular disease risk prediction in women: is there a role for novel biomarkers?

BACKGROUND Risk prediction is an integral part of the current US guidelines for cardiovascular disease in women. Although current risk prediction algorithms exist to identify women at increased 10-year risk of cardiovascular disease (CVD), clinicians and researchers have been interested in developing novel biomarkers that might improve predictive accuracy further. These biomarkers have led to important insights into the pathophysiology of CVD, but results for their ability to improve prediction or guide preventive therapy have been mixed. The incidence of CVD is lower in women than men, and the effects of a number of traditional biomarkers on CVD risk differ in women compared to men. Both of these factors influence the ability to accurately predict CVD risk. CONTENT We review the distinctive aspects of CVD risk prediction in women, discuss the statistical challenges to improved risk prediction, and discuss a number of biomarkers in varying stages of development with a range of performance in prediction. SUMMARY A variety of biomarkers from different pathophysiologic pathways have been evaluated for improving CVD risk. While many have been incompletely studied or have not been shown to improve risk prediction in women, others, such as high-sensitivity troponin T, have shown promise in improving risk prediction. Increasing inclusion of women in CVD studies will be crucial to providing opportunities to evaluate future biomarkers.