Cardiovascular risk assessment in women and men: A longitudinal biomarker-based approach

In an era marked by significant advancements in cardiovascular care and increased longevity, cardiovascular disease still remains a leading cause of death worldwide. In addition, a new and pressing challenge has arisen - an increasing number of individuals living with chronic heart conditions. Together, this underscores the critical need for precise and individualized risk assessment strategies that enhance personalized cardiovascular care. This approach is also known as ‘precision medicine’. Unlike conventional cardiovascular risk scores, which are typically static and measured at a single point in time (e.g. SCORE2, GRACE and the MAGGIC risk score), precision medicine advocates for individualized estimates of risk that may be updated as further information becomes available. In this context, circulating biomarkers have emerged, which are capable of detecting subtle changes in pathophysiological processes, disease states and disease progression. Given the often complex and dynamic nature of cardiovascular diseases, distinguishing patients at different levels of risk of adverse events based on a single measurement is challenging and requires a more advanced approach. This thesis demonstrates that circulating biomarkers possess the capability to assess disease risk across a wide spectrum of cardiovascular conditions, ranging from “presumably” healthy individuals to patients with acute coronary syndrome and chronic heart failure, with patient-specific, serial biomarker measurements being an attractive instrument to gather dynamic information about an individual’s future risk of cardiovascular disease.