Inflammatory Biomarkers in Coronary Artery Disease: Diagnostic and Prognostic Potential?

INTRODUCTION: Coronary artery disease (CAD) is a leading global cause of morbidity and mortality. Advances in treatment have resulted in a new, growing cohort of patients who require lifelong management. Although inflammation is firmly established as a driving force across all stages of atherosclerosis, the potential role of inflammatory biomarkers in improving disease prediction, phenotyping, and risk stratification remains uncertain and continues to be debated. OBJECTIVES: To examine the current evidence surrounding inflammatory biomarkers that demonstrate potential utility in the assessment of CAD across three key domains: (i) predicting incidence of CAD in asymptomatic individuals; (ii) predicting plaque rupture in patients with established CAD; and (iii) forecasting recurrent cardiovascular events and relevant adverse clinical outcomes, following an acute coronary syndrome. METHODS: We undertook a structured literature search using Embase (OVID), combining relevant MeSH terms and keywords. Boolean operators, truncation, and wildcards were used to further refine results, with sub-analyses undertaken on both recent (≤5 years) and earlier foundational studies. RESULTS: Biomarkers critically assessed range from established agents such as C-reactive protein and Fibrinogen to those currently utilised in a research capacity, including Interleukin-6, Galectin-3, Myeloperoxidase, and Tumour necrosis factor-alpha. We additionally discuss the conceivable clinical translation of each biomarker in the context of any key barriers to use. DISCUSSION AND CONCLUSIONS: Inflammatory biomarkers have the potential to improve coronary disease assessment, but do not currently hold an established place in the diagnosis, risk stratification, or prognostication of disease. Validating their clinical applications along different phases of the atherosclerotic process remains a distant but worthwhile target.