Book Review

Cardiovascular Biomarkers: Pathophysiology and Disease Management

N Engl J Med 2006; 355:2796-2797December 28, 2006

Article

Cardiovascular Biomarkers: Pathophysiology and Disease Management
(Contemporary Cardiology.) Edited by David A. Morrow. 620 pp., illustrated. Totowa, NJ, Humana Press, 2006. $175. ISBN: 1-58829-526-5

Since the 1950s, cardiac biomarkers have provided physicians with important information for managing the care of patients suspected of having had an acute myocardial infarction. In addition to clinical symptoms and typical electrocardiographic changes, elevated levels of cardiac biomarkers, particularly creatine kinase MB, have been considered essential in establishing the diagnosis of myocardial infarction. Over the past 15 years, other cardiac biomarkers have been identified, and they have proved useful in improving the diagnosis of a variety of cardiac diseases, in identifying persons at increased risk for a cardiovascular event, and in directing therapeutic decisions.

Given the many known cardiac biomarkers and the rapid explosion of information regarding their use, it has become a challenge for many clinicians to decide when and how to use them. In Cardiovascular Biomarkers, editor David Morrow has compiled an excellent resource that provides the information practicing clinicians need to integrate the use of cardiac biomarkers into their practice.

Morrow has thoughtfully organized the book around the various types of biomarkers. In this way, the clinician can pick a particular cardiovascular condition — such as myocardial necrosis, ischemia, inflammation, hemodynamic stress, platelet function, or dyslipidemia — and read about relevant biomarkers now in use, as well as those that may be available for use in the near future. Each section is divided into short chapters that provide overviews of the biology of the underlying cardiac process, the development of the relevant biomarker, the practical issues associated with analysis of the biomarker, and its clinical application. The chapters are written by internationally recognized experts in the field, and Morrow has done an excellent job of minimizing the stylistic differences and overlap of material that often occur in multiauthored texts.

The succinct chapters and the liberal use of figures and tables make the book an excellent reference work for physicians who want to refresh their memories or learn about a particular subject quickly. The background information concerning the biomarkers is comprehensive enough to make the book useful to laboratory personnel and medical trainees yet easily understandable by the practicing clinician. A particular strength of the book is its emphasis on clinical applicability. With well-recognized academics and companies advocating the use of new cardiac biomarkers, it can be difficult for the practicing clinician to distinguish hype from truth regarding their utility. This book presents a balanced view of the use of biomarkers by emphasizing clinical studies and evidence-based medicine. When possible, the contributors provide the busy clinician with diagnostic algorithms and pathways that point toward the proper use of biomarkers for diagnostic and therapeutic purposes.

The book comes with an electronic version of its contents on a CD-ROM that can be viewed on a computer or synchronized with a personal digital assistant. Unfortunately, the CD can be viewed only on one computer, which may be frustrating for anyone who works from more than one computer. Overall, however, the book nicely fits a niche not previously recognized.

Richard A. Lange, M.D.
Johns Hopkins Hospital, Baltimore, MD 21287
rlange3@jhmi.edu