Use Of Multiple Biomarkers To Estimate Cardiovascular Drug Efficacy: Advantage Of A Pre Score

In cardiovascular disease, drugs are targeted toward normalizing a single risk factor, the on-target effect. The ultimate goal of drug treatment is to provide long-term cardiovascular organ protection. In recent years, several trials have shown that drugs with promising effects on the on-target risk factor failed to improve long-term cardiovascular protection. One explanation for these failures is that a drug does not only affect the risk factor to which it is targeted but also other parameters, off-target effects, which may also affect long-term cardiovascular outcomes. The drug effect on these off-target effects may be as large or even larger than the on-target effect. The off-target drug effects may consequently have an important impact on the drug effect on cardiovascular outcomes.This chapter provides an overview of on-target and off-target effects of drugs used in cardiovascular risk management. Keynote in this chapter is that ignoring off-target effects of a drug may lead to severe misinterpretations about the long-term cardiovascular protective effect, with major consequences for society and individual patients. To solve this problem, all effects of a drug should be incorporated into a risk algorithm to obtain a more accurate estimation of the drug effect on long-term cardiovascular outcome.