New predictors of cardiovascular events are needed to improve the accuracy
of risk stratification. Such predictors should be easily measurable in the
population and potentially modifiable. This review reports on new biomarker
s that are closely linked to the pathogenic mechanisms underlying the progr
ession of the atherosclerotic plaque leading to rupture and thrombosis that
ultimately precipitate acute clinical events, such as stroke and myocardia
l infarction. These risk factors have been associated with subclinical or c
linical cardiovascular disease in large populations and include markers of
lipoprotein and lipid metabolism, vitamin Bit metabolism, fibrinolysis, coa
gulation, inflammation, infection, endothelial dysfunction, the angiotensin
system, and oxidative stress. For other key processes of atherosclerosis a
nd cardiac disease, such as apoptosis or programmed cell death, there are c
urrently no markers that can be measured noninvasively. Atherosclerosis is
a multifactorial condition and possibly only a subset of factors are the ma
in determinants of disease in a given patient. A better definition of the c
ardiovascular risk profile will help to better target primary and secondary
prevention. Further epidemiological studies are seeded to characterize the
actual predictive and clinical value of these new emerging cardiovascular
biomarkers.