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BJA Advance Access published online on October 30, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael303
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review Article

Methods of detecting atherosclerosis in non-cardiac surgical patients; the role of biochemical markers

G. M. Howard-Alpe 1 *, J. W. Sear 1, and P. Foex 1

1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK

* To whom correspondence should be addressed.
G. M. Howard-Alpe, E-mail: georgina.howard-alpe{at}nda.ox.ac.uk


  Abstract

Atherosclerosis is a common condition in both the developed and developing world and is now recognised to be an inflammatory condition leading to the development of ischaemic heart disease, cerebrovascular disease and peripheral vascular disease. Ischaemic heart disease is a major risk factor in the pathogenesis of perioperative adverse cardiovascular events which lead to significant morbidity and mortality within the high risk surgical patient population. Current methods of evaluating the likelihood of postoperative cardiovascular complications depend largely on risk scoring systems, and the preoperative assessment of the functional status of the cardiovascular system. However, the possible role of inflammation in the generation of atherosclerosis has led to the identification of several biochemical markers such as acute phase proteins, cellular adhesion molecules and cytokines. An alternative approach therefore is the measurement of preoperative levels of these biomarkers with the aim of assessing pre-existing disease activity.

This review summarises the pathophysiology of atherosclerosis and perioperative myocardial infarction, and discusses the possible future role of biomarkers in the risk stratification of patients undergoing non-cardiac surgery.

Keywords: surgery, non cardiac cardiovascular system, effects; biomarkers; atherosclerosis; C-reactive protein.
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