Innovative Approaches to Assess Intermediate Cardiovascular Risk Subjects: A Review From Clinical to Metabolomics Strategies

Frontiers in Cardiovascular Medicine

Andréa T. Faccio¹  Carolina R. C. Picossi¹  Marina F. M. Tavares¹  Coral Barbas²  Guilherme U. Monte³  Fernando A. Atik³  Raul D. Santos⁴  Viviane Z. R. Giraldez⁴  Leonardo J. S. R. Alves⁵  Aline M. A. Martins⁵  Henrique L. Machado⁵  Raphaela M. de Oliveira⁶  Mariana U. B. Paiva⁶  Diego V. N. Paiva⁶ 

[1] Center for Multiplatform Metabolomics Studies (CEMM), University of Sao Paulo, São Paulo, Brazil;Centre of Metabolomics and Bioanalysis (CEMBIO), San Pablo CEU University, Madrid, Spain;Department of Heart Transplant, Federal District Institute of Cardiology (ICDF), Brasilia, Brazil;Lipid Clinic, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil;School of Medicine, University Center of Brasilia (UniCeub), Brasilia, Brazil;School of Medicine, University of Brasilia, Brasilia, Brazil;

关键词: risk stratification;    coronary artery disease (CAD);    metabolomics;    atherosclerosis;    cardiovascular prevention;   

DOI  :  10.3389/fcvm.2021.788062

来源: DOAJ

【 摘 要 】

Current risk stratification strategies for coronary artery disease (CAD) have low predictive value in asymptomatic subjects classified as intermediate cardiovascular risk. This is relevant because not all coronary events occur in individuals with traditional multiple risk factors. Most importantly, the first manifestation of the disease may be either sudden cardiac death or acute coronary syndrome, after rupture and thrombosis of an unstable non-obstructive atherosclerotic plaque, which was previously silent. The inaccurate stratification using the current models may ultimately subject the individual to excessive or insufficient preventive therapies. A breakthrough in the comprehension of the molecular mechanisms governing the atherosclerosis pathology has driven many researches toward the necessity for a better risk stratification. In this Review, we discuss how metabolomics screening integrated with traditional risk assessments becomes a powerful approach to improve non-invasive CAD subclinical diagnostics. In addition, this Review highlights the findings of metabolomics studies performed by two relevant analytical platforms in current use–mass spectrometry (MS) hyphenated to separation techniques and nuclear magnetic resonance spectroscopy (NMR) –and evaluates critically the challenges for further clinical implementation of metabolomics data. We also discuss the modern understanding of the pathophysiology of atherosclerosis and the limitations of traditional analytical methods. Our aim is to show how discriminant metabolites originated from metabolomics approaches may become promising candidate molecules to aid intermediate risk patient stratification for cardiovascular events and how these tools could successfully meet the demands to translate cardiovascular metabolic biomarkers into clinical settings.

【 授权许可】

Unknown