Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease

ABSTRACT

Introduction

Coronary Artery Disease (CAD) is a prevalent condition characterized by the presence of atherosclerotic plaques in the coronary arteries of the heart. The global burden of CAD has increased significantly over the years, resulting in millions of deaths annually and making it the leading health-care expenditure and cause of mortality in developed countries. The lack of cost-effective strategies for monitoring the prognosis of CAD warrants a pressing need for accurate and efficient markers to assess disease severity and progression for both reducing health-care costs and improving patient outcomes.

Area covered

To effectively monitor CAD, prognostic biomarkers and imaging techniques play a vital role in risk-stratified patients during acute treatment and over time. However, with over 1,000 potential markers of interest, it is crucial to identify the key markers with substantial utility in monitoring CAD progression and evaluating therapeutic interventions. This review focuses on identifying and highlighting the most relevant markers for monitoring CAD prognosis and disease severity. We searched for relevant literature using PubMed and Google Scholar.

Expert opinion

By utilizing the markers discussed, health-care providers can improve patient care, optimize treatment plans, and ultimately reduce health-care costs associated with CAD management.

Plain Language Summary

Coronary artery disease is a narrowing or blockage of coronary arteries due to the formation of plaque. The main risk factors are inflammation, aging, high cholesterol, shear stress, obesity, and smoking. Narrowing of the arteries results in decreased blood supply (nutrient and oxygen) to the tissue precipitating ischemia presented as angina or myocardial infarction. During ischemic events, there occurs a change in the expression of various molecular and cellular components and increased expressions of many of these factors have been used as biomarkers to diagnose the pathology. Myoglobin, fatty acid-binding proteins, and glycogen phosphorylase isoenzyme BB are early biomarkers, troponin-T and troponin-I are late biomarkers, while creatine kinase-myocardial band is a biomarker in the first 10–12 h for the diagnosis of AMI. However, there is a need for a panel of biomarkers that can help in the prediction, prognosis, and diagnosis of disease progression (atherosclerosis), pre-ischemic and ischemic events, and post-MI periods to design the treatment strategies in a specific and sensitive manner. There is a need for cost-effective sensitive biomarkers that can prevent progression, risk stratify, predict, diagnose, and prevent MI in a timely manner. In this comprehensive review, we discuss the key markers of substantial utility for monitoring coronary artery disease progression and the efficacy of therapeutic intervention among various markers of interest.

KEYWORDS:

• Coronary artery disease
• biomarkers
• disease severity
• prognosis
• patient care

Article highlights

• Accurate measurements of CAD prognosis and severity are crucial for risk stratification and monitoring of patients, aiming to improve health outcomes and reduce health-care costs.

• Biomarkers such as amyloid A, troponin, cytokines, MMPs, BNP and NT-proBNP, PAPP-A, RDW, and calcium score show promise in predicting cardiac outcomes and assessing CAD progression.

• Elevated levels of these biomarkers have been associated with increased morbidity and mortality, higher risk of cardiovascular events, symptomatic heart failure, and nonfatal myocardial infarction in CAD patients.

• The use of these biomarkers can aid in risk stratification, monitoring disease progression, and optimizing treatment strategies for individuals with CAD.

• Lower HRV is associated with a higher risk of fatal or non-fatal cardiovascular disease, while reduced HRV is linked to an increased risk of sudden cardiac arrest, non-sudden cardiac death, and death from non-cardiac causes in patients with CAD.

• HRV serves as a valuable marker for assessing autonomic nervous system function, cardiovascular disease risk, and the effectiveness of interventions such as beta-blocker medications and percutaneous coronary intervention.

• Incorporating these biomarkers into routine clinical practice can enhance the accuracy of CAD prognosis, inform treatment decisions, and improve patient outcomes.

• Further research and validation are needed to establish the clinical utility, standardization, and integration of these biomarkers into the management of CAD, ensuring their widespread effectiveness and benefit for patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by the research grants [R01 HL144125 and R01HL147662] from the National Heart, Lung, and Blood Institute, National Institutes of Health, USA. The contents of this original manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.