Precision Medicine in Cardiology: An Evolving Understanding of Biomarkers in Coronary Artery Disease Prevention a 10-year Thematic Review

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Precision medicine, utilizing biomarkers for early detection and prevention of CAD, has emerged as a promising approach to improve patient outcomes. This systematic review aims to summarize the current state of knowledge regarding biomarkers in CAD prevention, focusing on the most promising and well-studied biomarkers over the past decade. Methods: Following PRISMA guidelines, a systematic review was conducted. PubMed, Embase, and Cochrane Library databases were searched for relevant studies published between 2013 and 2023. Inclusion criteria were original research articles, systematic reviews, or meta-analyses focusing on biomarkers in CAD prevention, with sufficient data on biomarker performance. Exclusion criteria were case reports, editorials, conference abstracts, and studies on biomarkers in established CAD. The STARD “Standards for Reporting Diagnostic accuracy studies” 2015 guideline criteria for assessing diagnostic tools was also utilized to ensure the precision of the methodology and help readers to appraise the applicability of the study findings and the validity of conclusions and recommendations. The main outcome assessed was the association between biomarkers and CAD risk, using various statistical methods. The study is registered with PROSPERO (registration number: CRD42023 564048). Findings: The search identified 2,345 articles, of which 40 met the inclusion criteria, including 32 original research articles, 6 systematic reviews, and 2 meta-analyses. The biomarkers studied included traditional risk factors (lipid profiles and blood pressure), novel biomarkers (high-sensitivity C-reactive protein, homocysteine, and adipokines), and imaging biomarkers (coronary artery calcium scores and carotid intima-media thickness). Several studies demonstrated the association between these biomarkers and increased CAD risk, independent of traditional risk factors. Multi-marker approaches combining various biomarkers showed improved accuracy in CAD risk assessment compared to traditional risk factors alone. The risk of bias and variability between studies were assessed and reported. Interpretation: This systematic review provides a comprehensive overview of the current landscape of biomarkers in CAD prevention. While traditional risk factors remain important, novel and imaging biomarkers have shown promise in improving risk stratification and guiding personalized prevention strategies. However, challenges remain in translating biomarker research into clinical practice, including the need for standardized guidelines, cost-effectiveness analyses, and further research on multi-marker approaches and personalized prevention strategies. Addressing these challenges and developing evidence-based guidelines for biomarker use in CAD prevention can improve risk assessment accuracy, tailor prevention strategies, and ultimately reduce the global burden of CAD.