Coronary artery disease (CAD) remains one of the major causes of
morbidity and mortality in the world. The importance of developing advanced
diagnostic, prognostic, and therapeutic monitoring tools cannot be overemphasized.
Biomarkers have emerged as invaluable resources for tracking disease outcomes,
assessing severity, and evaluating treatment efficacy. This review will explore the
landscape of biomarkers for CAD, focusing on their role in providing precision
medicine approaches for this complex condition. Biomarkers, such as Troponin I (TnI)
and C-reactive protein (CRP), have been established in identifying myocardial damage
and inflammation, respectively, which correlate with the severity of coronary
atherosclerosis and high-risk plaque characteristics. In parallel, new biomarkers based
on transcriptomics, such as circulating microRNAs (e.g., miR-126, miR-223, miR-19),
may open new avenues for early detection and risk stratification. These RNA
molecules are linked to the molecular basis of CAD, which is the connection between
endothelial dysfunction and inflammatory cascades with adverse cardiovascular events.
Quantitative imaging biomarkers include coronary artery calcium scores (CACS) and
the features of high-risk plaque (HRP) found by coronary computed tomography
angiography (CCTA). They provide a real-time assessment of the plaque burden and
vulnerability. Increasing evidence is emerging with the incorporation of biomarker
profiles and imaging tools for improved risk stratification and, consequently,
individualized treatment pathways. Such biomarkers include Growth Differentiation
Factor-15 (GDF-15) and soluble ST2, which are potential candidates for predicting the
disease's progression and the response to pharmacological interventions. Recent
advances in the omics technologies, namely genomics, proteomics, and metabolomics, have expanded the range of CAD biomarkers with the potential to identify patientspecific therapeutic targets. However, significant challenges remain in translating such
discoveries into clinical practice because of variability in biomarker expression, lack of
standardization, and large-scale validation studies.
Keywords: Adhesion molecule, Apolipoprotein B, C-reactive protein, Cardiac troponins, Circulating microRNAs, Coronary artery disease, Endothelial dysfunction, Endothelin-1, Exosomes, Molecular biomarker.
