Looking to the Future: Spotlight on Emerging Biomarkers for Predicting Cardiovascular Risk

Abstract

Coronary artery disease (CAD) continues to be a major contributor to death and disability worldwide. Emerging biomarkers that are linked to CAD pathophysiology have the potential to phenotype CAD severity and identify individuals at high risk for experiencing future CAD events. This review discusses the utility of emergent biomarkers for CAD risk prediction. Monocytes and neutrophils are key effectors of cardiovascular inflammation, and aspects of their biology have recently been associated with cardiovascular risk. In particular, intermediate (Mon2) monocytosis is robustly associated with major adverse cardiovascular events (MACE) and surrogate markers of neutrophil extracellular trap (NET) formation have also emerged as independent predictors of MACE. MicroRNAs (miRNAs) are essential regulators of cardiovascular physiology, and a wealth of data suggests that circulating miRNA levels are linked with risk of future CAD events. A number of studies demonstrate the predictive value of a multi-miRNA panel in assessing risk and this approach is likely to more accurately predict progression of CAD to a clinically overt event, over a single-marker approach. A number of emerging inflammatory and miRNA biomarkers hold promise for phenotyping an individual’s risk of future CAD events. Research into these particular biomarkers is in its infancy, and independent validation and methodological standardization is now required to facilitate their translation into clinical use. Ultimately, a biomarker-based methodology for identifying a high-risk phenotype will allow for targeted and personalized therapy for CAD prevention.