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Cardiovascular biomarkers for risk stratification in primary prevention
Franz–Josef Neumann, James A. de Lemos, Fred S. Apple, Darryl P. Leong. European Heart Journal, 2025-07-08
Topic: Risk, prevention and care in population studies
The foundation of preventive cardiology relies on the assessment of cardiovascular (CV) risk using scores based on traditional risk factors. However, risk models based on these risk factors provide only moderate discrimination and some are poorly calibrated, highlighting a need for improved approaches to risk assessment. Cardiovascular biomarkers, including cardiac troponins, natriuretic peptides, and inflammatory markers, can be used to reclassify CV risk, especially in individuals at intermediate risk, providing opportunities for optimization of primary prevention strategies. This review provides an overview of the characteristics of a circulating biomarker that would promote its clinical use and on the existing evidence behind CV biomarkers for risk stratification. Hundreds of studies have described robust associations between CV biomarkers and incident CV events. However, the incremental value, when biomarkers were added to conventional risk factor models, has generally been modest in terms of improvement in model performance. The review also describes emerging proteomic techniques that enable high-throughput analysis of circulating proteins, presenting opportunities for improved CV risk prediction. Despite encouraging findings, challenges remain in integrating these biomarkers into clinical practice, and there is a need for evidence from clinical trials to demonstrate their cost-effective impact on reducing CV events. While biomarkers hold promise for enhancing CV prevention strategies, their routine application in clinical settings requires further innovation and investigation to establish clear treatment guidelines and optimize patient outcomes.
Key findings
- Hundreds of studies have described robust associations between CV biomarkers and incident CV events.
- However, the incremental value, when biomarkers were added to conventional risk factor models, has generally been modest in terms of improvement in model performance.
- The review also describes emerging proteomic techniques that enable high-throughput analysis of circulating proteins, presenting opportunities for improved CV risk prediction.
- Despite encouraging findings, challenges remain in integrating these biomarkers into clinical practice, and there is a need for evidence from clinical trials to demonstrate their cost-effective impact on reducing CV events.
- While biomarkers hold promise for enhancing CV prevention strategies, their routine application in clinical settings requires further innovation and investigation to establish clear treatment guidelines and optimize patient outcomes.
Why it matters
This review is about cardiovascular biomarkers for predicting heart risk, not Alzheimer's disease. It reports that biomarkers are strongly linked to cardiovascular events but add only modest improvement when added to conventional risk factor models, and that clinical trial evidence is still needed.
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Study details
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (European Heart Journal) |
| Journal's citation record | 3 / 4 | European Heart Journal: journal h-index 456 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 27 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 5 / 6 | Cited 24.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 2 / 4 | Cited 27 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Darryl P. Leong: h-index 66 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Minnesota: institution h-index 1,568 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 10 institution(s) in 4 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40795138) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Neumann, F., de Lemos, J. A., Apple, F. S., & Leong, D. P. (2025). Cardiovascular biomarkers for risk stratification in primary prevention. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf517
Vancouver
Neumann F, de Lemos JA, Apple FS, Leong DP. Cardiovascular biomarkers for risk stratification in primary prevention. European Heart Journal. 2025. doi:10.1093/eurheartj/ehaf517. PMID: 40795138.
BibTeX
@article{neumann2025-40795138,
author = {Neumann, Franz–Josef and de Lemos, James A. and Apple, Fred S. and Leong, Darryl P.},
title = {{Cardiovascular biomarkers for risk stratification in primary prevention}},
journal = {European Heart Journal},
year = {2025},
doi = {10.1093/eurheartj/ehaf517},
pmid = {40795138},
url = {https://doi.org/10.1093/eurheartj/ehaf517}
}