Non‐traditional biomarkers of atherosclerosis in stable and unstable coronary artery disease, do they differ?

Background: Biomarkers of atherosclerosis are emerging as a potential tool for assessment of coronary artery disease (CAD) patients. As acute coronary syndrome (ACS), and stable CAD are distinguished in their pathophysiology it is conceivable that they are also characterized by different biomarkers of atherosclerosis. Methods: We systematically reviewed the literature for clinical studies of several non‐traditional biomarkers of atherosclerosis reflecting various pathophysiological processes, namely macrophage‐activity, oxidative‐stress, tissue remodeling, and thrombosis in ACS and stable CAD to determine whether circulating biomarkers are differently expressed/predict outcome in these two clinical conditions. Results: Macrophage‐activity (monocyte chemoattractant protein‐1, neopterin), tissue‐remodeling (matrix metalloproteinase‐9) and thrombosis (tissue‐factor) related biomarkers were consistently elevated in ACS compared to stable CAD, in accordance with the pathophysiological role of these mediators in plaque rupture, characterizing ACS. Thus, these biomarkers may be applicable for diagnosis of ACS. Additionally, neopterin was consistently shown to predict outcome in both stable and ACS patients and myeloperoxidase was strongly shown to predict outcome in ACS, implying for their potential role in risk stratification of these patients. Conclusions: As ACS and stable CAD are characterized by different pathophysiological processes, it appears that the biomarkers that are associated with them are differently expressed in these two clinical conditions.