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Biomarkers in primary prevention

Meaningful diagnosis based on biomarker scores?

Biomarker in der Primärprävention

Aussagekräftige Diagnose anhand von Biomarkerwerten?

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Cardiovascular (CV) risk assessment is based on the utilization of risk scores, enabling clinicians to estimate an individual’s risk to develop CV pathologies and events. Such risk scores comprise classic CV risk factors such as smoking, diabetes, hypertension, and blood cholesterol levels. Recently, other CV biomarkers such as cardiac troponins have been suggested and evaluated as alternative biomarkers not only in the acute diagnostic setting of myocardial infarction, but also as markers for risk stratification in the general population. In this review, we summarize the current knowledge on biomarkers in the field of primary prevention in cardiovascular disease (CVD). Furthermore, we present potential alternative biomarker-based strategies for CV risk assessment. In this respect we provide an outlook on the potential use of genomic variation as well as circulating non-coding RNAs to complement current risk assessment strategies so as to further personalize risk stratification in CVD.


Für die Primärprävention kardiovaskulärer Erkrankungen ist eine detaillierte Risikoabschätzung durch klinisch tätige Ärzte in Bezug auf die Entwicklung kardiovaskulärer Erkrankungen und Ereignisse wichtig. Zu diesem Zweck werden sog. Risikoscores genutzt, welche auf den klassischen kardiovaskulären Risikofaktoren wie Rauchen, Diabetes, Bluthochdruck und Cholesterin basieren. In den vergangenen Jahren wurden andere kardiovaskuläre Biomarker wie kardiale Troponine als weitere Faktoren nicht nur bei der akuten Diagnostik eines Herzinfarkts, sondern auch für die Risikostratifizierung in der Allgemeinbevölkerung vorgeschlagen und bewertet. Dieser Artikel fasst die aktuellen Erkenntnisse zu Biomarkern im Bereich der Primärprävention bei Herz-Kreislauf-Erkrankungen zusammen. Darüber hinaus werden perspektivisch alternative biomarkerbasierte Strategien wie die potenzielle Nutzung von genomischen Variationen und zirkulierenden nichtkodierenden RNA-Molekülen zur Vervollständigung der Bewertung des individuellen kardiovaskulären Risikos erörtert.

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C.S. is the recipient of a research fellowship by the Deutsche Forschungsgemeinschaft (DFG) (SCHU 2983/1‑1 and SCHU 2983/2-1). T.Z. is funded by the German Centre for Cardiovascular Research (DZHK) (81Z0710102).

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Correspondence to Tanja Zeller PhD.

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C. Schulte and T. Zeller declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Schulte, C., Zeller, T. Biomarkers in primary prevention. Herz 45, 10–16 (2020). https://doi.org/10.1007/s00059-019-04874-2

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  • Blood lipids
  • Risk factors
  • Cardiovascular disease
  • Troponin
  • Risk assessment


  • Blutfette
  • Risikofaktoren
  • Herz-Kreislauf-Erkrankungen
  • Troponin
  • Risikoabschätzung