Emerging biomarkers for cardiovascular risk prediction and personalized treatment options in patients with polyvascular atherosclerotic disease

Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality globally. Patients with polyvascular disease (PolyVD), defined as ASCVD affecting ≥2 arterial beds, are at high-risk for adverse events. This PhD thesis aimed to investigate the prognostic role of cardiovascular biomarkers and the impact of PolyVD in patients undergoing interventional procedures on clinical outcomes. Data from national and international cohorts were analyzed. High-sensitivity troponin T/I was found to be independently associated with all-cause mortality in both mono- and polyvascular ASCVD, but not with major adverse cardiovascular events (MACE). High-sensitivity C-reactive protein (hsCRP), a marker of chronic low-grade inflammation, was significantly associated with MACE in PolyVD patients undergoing percutaneous coronary intervention (PCI), whilst this was not observed in those without PolyVD. The interaction between lifestyle risk factors (LRF) - i.e. smoking, overweight, physical inactivity, and poor diet - atherosclerosis extent, and hsCRP levels was evaluated in a population-based cohort. LRF were independently associated with hsCRP concentrations regardless of ASCVD severity, showcasing the interplay between LRF, atherosclerosis and inflammatory burden. The analysis further demonstrated that PolyVD was associated with increased MACE rates 12 months after left-main PCI, underscoring the adverse prognostic implications of non-coronary ASCVD in complex revascularization procedures. In conclusion, this thesis provides novel insights into the prognostic relevance of biomarkers in patients with PolyVD and highlights the clinical impact of atherosclerotic disease extent on outcomes following left-main PCI.