Biomarkers for Personalised Primary or Secondary Prevention in Cardiovascular Diseases: A Rapid Scoping Review

Abstract

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality globally. Early detection and personalised prevention strategies are crucial for reducing the burden of CVD. The use of biomarkers plays a pivotal role in identifying individuals at risk and facilitating timely interventions. This rapid scoping review aims to identify and evaluate current research on biomarkers used for primary and secondary personalised prevention of CVD, highlighting evidence gaps and the integration of digital technologies. A comprehensive search was conducted in Medline and Embase databases from January 2020 to February 2023. Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and PRISMA-ScR guidelines were followed. A total of 775 studies were included, with ischemic heart disease (IHD) and stroke being the most investigated CVDs. Molecular, cellular, imaging, physiological, and anthropometric biomarkers were included. Molecular biomarkers, particularly genetic and biochemical, were the most researched. For secondary prevention, there was considerable research using imaging biomarkers. Genetic biomarker research was the most frequent category of biomarker identified, particularly using variant analysis and polygenic scores, followed by biochemical, imaging, and physiological biomarkers. There was also evidence of the integration of artificial intelligence to enhance the predictive capabilities of these biomarkers. Despite progress, research gaps were identified for less common CVDs, such as aortic aneurysm and nonrheumatic valvular heart disease, and limited research investigating other molecular biomarker types, such as epigenetics and transcriptomics.

Keywords: biomarker; cardiovascular disease; early detection; precision medicine; prevention.

Figure 1

Cardiovascular diseases scoping review PRISMA flowchart.

Figure 2

Bubble plot representing the number of papers identified for primary prevention of cardiovascular disease where risk factors were considered; the size of the bubble represents the number of papers, and the colour represents a type of biomarker. CVD—cardiovascular disease; MACE—major adverse cardiovascular event.

Figure 3

Bubble plot representing the number of papers identified for primary prevention of cardiovascular disease by each population group, where the size of the bubble represents the number of papers, and the colour represents a type of biomarker. No papers looked at family history as a population group in primary prevention. Evidence gap map 1: an interactive version linking to the references identified and used in this bubble plot is accessible via: https://phg-foundation.github.io/PROPHET/Phase_1_codes/EGMs/EGM_cvd_primary_segment_biomarker.html (accessed on 10 July 2023).

Figure 4

Bubble plot representing the number of papers identified for secondary prevention of cardiovascular disease for each population type, where the size of the bubble represents the number of papers, and the colour represents a type of biomarker. CKD—chronic kidney disease; CVD—cardiovascular disease; MACE—major adverse cardiovascular event. There was one paper that looked at family history as a population group in secondary prevention of cardiomyopathy and myocarditis. Evidence gap map 2: an interactive version linking to the references identified in the scoping review and used in this bubble plot is accessible via: https://phg-foundation.github.io/PROPHET/Phase_1_codes/EGMs/EGM_cvd_secondary_segment_biomarker.html (accessed on 10 July 2023).