Molecular epidemiology: principles and practices. Schulte PA, Perera FP, eds., San Diego, CA: Academic Press, 1993 Apr; :341-363
Cardiovascular epidemiology has made use of biomarkers over several decades of research and can, therefore, be viewed as a resource for methods in molecular epidemiology that can be applied to other diseases. This chapter selects examples from the vast literature in this area to illustrate some of the challenges of etiologic research involving biomarkers and, at the same time, provides examples of some of the exciting advances being made in cardiovascular epidemiology. Cardiovascular diseases span a broad range of pathologic processes, including coronary heart disease (CHD), hypertension, cardiomyopathies, valvular abnormalities, and arrhythmias. This chapter focuses predominantly on the application of lipid and lipoprotein biomarkers to CHD. Historically, cardiovascular studies began with the measurement of very broad categories of lipids, such as total cholesterol, and progressed to more specific lipid-related biomarkers, such as very low density lipoprotein (VLDL), low density lipoprotein (LDL), high density lipoprotein (HDL), low density lipoprotein subclass phenotypes A and B, and plasma levels of apo AI and B (Keys and Parlin, 1966; Kannel et at., 1971 b; Brunzell et at., 1984; Austin et at., 1988,1990b). Genetic markers such as restriction fragment length polymorphisms (RFLPs) for apo B, apo E, and the LDL receptor genes have been used to evaluate directly the inherited contribution to CHD (Humphries, 1987; Friedl et aI., 1990b; Dallongeville et at., 1991). Thus, a range of lipid markers and their environmental and genetic determinants have been used in epidemiologic studies to evaluate risk of developing coronary heart disease.