Overview

According to a report released in 2017 by the Cardiovascular Prevention and Control branch of the National Ministry of Health, the prevalence and subsequent mortality, despite progress in prevention and treatment, is still on the rise. The number of patients in China with cardiovascular diseases is estimated at 290 million. (Strokes – 13 million, CHD – 11 million, Pulmonary heart disease – 5 million, Heart failure – 4.5 million, Rheumatic heart disease – 2.5 million, Congenital heart diseases – 2 million, Hypertension – 270 million). Cardiovascular deaths account for 40% of all deaths, a rate higher than cancer and other diseases. It is estimated that 45.01% of deaths in rural areas and 42.61% of deaths in urban areas are due to cardiovascular diseases. The number of cardiovascular patients are expected to continue rising in the next 10 years, adding to its burden on society.

1. Risk Factors

Cardiovascular disease is the manifestation of both systemic vascular disease and vascular disease relating to the heart. The risk factors are a combination of biological, pathological and psychosocial factors. Examples of such risk factors are smoking, obesity, poor blood viscosity, hypertension and hyperlipidemia.
Age is also a risk factor. Cardiovascular disease generally occurs in the elderly or middle aged. However due to poor work-life balance and increased stress, the number of younger people (between 35-50) with cardiovascular diseases is on the rise. Having multiple risk factors of substantially increases one’s risk of cardiovascular or cerebrovascular disease.

2. Clinical Manifestations

Common symptoms of cardiovascular disease are: Crushing, tight pain posterior to the sternum (especially angina), referred pain in the left arm, palpitations, dyspnea, chest tightness, paroxysmal nocturnal dyspnea, oedema, cyanosis, syncope, cough, hemoptysis, fatigue, upper abdominal pain, nausea and vomiting etc.

Investigations and Diagnosis

ReLIA’s Biomarker Guide

Imaging remains as a crucial investigative technique in diagnosing cardiovascular disease. However, laboratory tests for biomarkers help provide an indication whether the patient is more likely to have cardiovascular disease. This allows for better resource management and reduction in cost. Understanding what does each biomarker indicate for cardiovascular disease is therefore vital.

1. Hypersensitive Troponin I (hs-cTnl)

Hypersensitive Troponin is an incredibly sensitive and practical biomarker for myocardial injury. With the highest sensitivity and specificity, hs-cTnl can be used as an independent diagnostic indicator for myocardial infarction. Due to its high sensitivity, even small amounts of damage to the myocardium can be detected. As myocardial injury is very strong evidence of myocardial disease, early detection of this allows for a more rapid diagnosis and treatment.

2. Troponin I (cTnl)

Troponin is a biomarker for myocardial injury and especially necrosis. Elevated troponin values suggest myocardial injury, which can be seen in an acute MI, unstable angina, pulmonary infarction, heart failure, acute pancreatitis and other connective tissue diseases. The higher the value, the more widespread the damage. In patients with acute myocardial infarction, cTnl is released between 3-6 hours after the incidence. Levels peak at 10-24 hours and returns to normal levels in 10-15 days and 5-7 days for cTnT and cTnl respectively. However, it must be noted that those with renal insufficiency may have elevated levels of troponin.

3. N-terminal pro-brain natriuretic peptide (NT-proBNP)

Compared to BNP, NT-proBNP has a longer half life (1-2 hours compared to BNP’s 20 minutes), a higher concentration in blood (15-20 times that of BNP) and is also biologically inactive. It also wont be affected by BNP related drugs. Therefore, NT-proBNP is recognized as a good biochemical marker that reflects cardiac function. It can be used to diagnose symptomatic heart failure, estimate the prognosis of patients with heart failure and acute coronary syndrome and to monitor treatment.

4. Myoglobin (MYO)

MYO plays an important role in the oxidative function of cell membranes. As it’s molecular size is relatively small, myoglobin is the first biomarker to enter the bloodstream once cardiomyocytes are damaged. It also spreads faster, especially compared to CK-mB or cTnl/cTnT. However, because myoglobin is also released from damage to skeletal muscle, its specificity is relatively low.

5. Myeloperoxidase (MPO)

MPO is a newly used biomarker to predict the risk of adverse cardiovascular events in patients with acute coronary syndrome (ACS), especially in those with low troponin levels. Elevated MPO suggests that the patient has potential inflammation in the coronary arteries or that the plaque is unstable but not completely blocked. Therefore, MPO is one of the inflammatory markers used in the early diagnosis of ACS. MPO levels are not only associated with susceptibility to coronary artery disease, but also predict the risk of early myocardial infarction.

6. Creatine kinase isoenzyme (CK-MB)

CK-MB has long been regarded as one of the most specific enzyme biomarkers in the diagnosis of myocardial injury. It is currently recommended by the American Heart Association and the European Society of Cardiology that detection of CK-MB levels is clinically crucial for those with heart disease due to its sensitivity and specificity.

7. Heart-type fatty acid binding protein (H-FABP)

H-FABP is small cytoplasmic protein that is involved in the growth and differentiation of cardiomyocytes. Blood levels of h-FABP in normal people are very low or absent. However, these levels will rapidly increase in acute myocardial infarction. Studies have shown that h-FABP is more specific to myoglobin in myocardial damage. It is therefore a novel biomarker in the early detection of myocardial infarction.

8. D-dimers

D-dimer is a fibrin degradation product present after fibrinolysis. Blood levels of D-dimers increase in disseminated intravascular coagulation, kidney disease, organ transplant rejection and thrombolytic therapy. As long as there is active thrombotic and fibrinolytic activity in the body, levels of D-dimers will rise. For elderly or hospitalized patients, elevated D-dimer levels can be due to abnormal coagulation caused by bacteremia or other diseases.
For cardiovascular diseases, we offer comprehensive myocardial testing programs including detection ofhypersensitive troponin (hs-cTnI), troponin (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), myoglobin Cardiovascular diseases such as protein (MYO), myeloperoxidase (MPO), creatine kinase isoenzyme (CK-MB), heart-type fatty acid binding protein (H-FABP), D-dimer that show results within 2-8 minutes.