Haemostatic and inflammatory markers in coronary heart disease
Many prospective blood-based epidemiological studies have investigated various inflammatory markers as potential predictors and/or determinants of coronary heart disease (CHD) in the general population, such as plasma fibrinogen and C-reactive protein. The interpretation of these studies, has, however, generally been complicated by limited sample size, selective publication, and, most importantly, “confounding” by causative risk factors. Further clarification of the predictive abilities of these factors can be addressed by conducting larger studies with serial measurements and by pooling of individual participant data from existing prospective studies of cardiovascular disease (as is in the Fibrinogen Studies Collaboration, which comprises 38 cohorts, a total of about 200 000 study participants, and about 10 000 incident cardiovascular cases). Further clarification of the possible causative relevance of these markers can be achieved by genotyping polymorphisms in genes that encode levels of these circulating markers, and integrating this information with data on plasma levels of biomarkers in sufficiently large case-control studies (ie, tests of causality by “Mendelian randomization”). This presentation will illustrate how such methods can help shed new light on the relevance of novel biomarkers in CHD by focusing on recently available data in relation to fibrinogen and C-reactive protein.