A Systematic Review on Novel Biomarkers and Multiple-Marker Approach for Cardiovascular Diseases and their Clinical Applications

Abstract

In spite of several efforts to prevent and treat atherosclerosis, cardiovascular disease (CVD) remains a major cause of morbidity and mortality worldwide, and its prevalence is expected to rise in the coming years. A marked reduction in mortality rates for coronary heart disease (CHD) has been observed in western countries over the last few decades, thanks to improvements in acute care and prevention strategies; however, both CVD prevalence and mortality have exponentially increased in low- and middle-income countries over the same period, likely due to globalization. World-wide, CVD cause the majority of deaths and disabilities. A primary prevention strategy for CVD relies on identifying high-risk individuals early on. The need for accurate risk stratification is evident here. Biomarkers that predict cardiovascular events are becoming more prevalent. In CVD management, biomarkers play a critical role in defining, prognosticating, and making decisions. Several promising biomarkers are reviewed here that provide diagnostic and prognostic information. It is possible to diagnose myocardial infarction (MI) in the early hours following symptoms by using the myocardial tissue-specific biomarker cardiac troponin, high-sensitivity cardiac troponin assays and heart-type fatty acid binding protein. The presence of inflammation markers such as growth differentiation factor-15, high-sensitivity C-reactive protein, fibrinogen, and uric acid can predict the risk of MI and death. Myeloperoxidase, matrix metalloproteinases, and plasma protein A associated with pregnancy predict the risk of acute coronary syndrome. The authors also explored papers mentioning some emerging areas, such as micro-RNA assessment. Each biomarker represents a different aspect of atherosclerosis development. Also, CVD is also a comorbidity for several chronic diseases, including type 2 diabetes mellitus (T2DM), chronic kidney disease, and chronic obstructive pulmonary disease. Therefore, biomarkers appear to be the most convenient option for screening and monitoring CVD patients. Ideally, a biomarker should be widely available, inexpensive, and reliable. This purpose has been served by several biomarkers over the past few decades, and several others are currently being developed. In specific populations, these biomarkers are used to predict cardiovascular risk. According to our knowledge, no biomarker for CVD is routinely used or scientifically validated in the general population and does not appear in cardiovascular risk scores. In order to spread knowledge about novel biomarkers that can be used to predict and/or manage cardiovascular risk, we proposed a review topic for analyzing previously published data systematically in order to draw robust conclusions regarding the potential use of biomarkers in CVD research.