Zooming in on microRNAs for refining cardiovascular risk prediction in secondary prevention

This editorial refers to ‘Circulating microRNAs strongly predict cardiovascular death in patients with coronary artery disease: results from the large AtheroGene study’, by M. Karakas et al ., on page doi:10.1093/eurheartj/ehw250 Atherosclerosis is a leading cause of death and disability worldwide, so that recent efforts are focused on strategies for preventing cardiovascular events. Due to its multifactorial nature, such approaches against atherosclerosis are based on concomitant treatment of multiple risk factors, aiming to reduce risk factor levels in patients with the highest risk of developing a cardiovascular event.1 Therefore, a valid assessment of cardiovascular risk is of paramount importance for preventive strategies to scrutinize novel biomarkers, to identify potential therapeutic targets, and to enable and improve a cost-effective implementation of preventive treatments. Although cardiovascular diseases reflect a continuum of mechanisms underlying the gradually progressing atherosclerosis, prevention is commonly divided into primary and secondary measures. Based on population studies and multicentre randomized clinical trails, several calculators have been established to estimate cardiovascular risk accurately based on demographic and biochemical parameters. To date, >100 risk-scoring methods are available and able to predict different cardiovascular outcomes such as coronary heart disease (CHD), cardiovascular disease (CVD), and cardiovascular death.2 For example, the Systematic Coronary Risk Evaluation (SCORE), which predicts the 10-year risk of fatal CVD, has been developed on data deriving from 12 European cohorts and it is currently implemented in the European guidelines for prevention of CVD.1 This algorithm allows the clinician to categorize patients for their risk of cardiovascular death (e.g. low, moderate, high, very high), providing an useful tool to drive subsequent therapeutic choices. This approach is valuable in primary prevention, whereas patients with …