Editorial: Blood Biomarkers in Cardiovascular Diseases

Yan Xu ¹ QIANG Liu ² Wen-Jun Tu ^1*

• ¹ Beijing Tiantan Hospital, Capital Medical University, Beijing, China
• ² Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing Municipality, China

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, underscoring the urgent need for improved diagnostic, prognostic, and therapeutic strategies (1). Blood biomarkers have emerged as indispensable tools in this regard, offering insight into the pathophysiological mechanisms underlying CVD and providing clinically relevant information for risk stratification and treatment optimization (2). These biomarkers not only aid in the monitoring and analysis of the spectrum but also enhance our understanding of the underlying pathogenic mechanisms of CVD (3,4). This special issue explores recent advancements in blood biomarkers for CVD, featuring seven studies that extend our understanding beyond mere associations and move toward mechanistic insights, clinical applicability, and predictive modeling (https://www.frontiersin.org/research-topics/57019/blood-biomarkers-in-cardiovascular-diseases). The selection of these studies is driven by their relevance to contemporary cardiovascular research, their methodological rigor, and their potential to impact clinical practice.One of the highlighted biomarkers in this issue is red cell distribution width (RDW), a measure of erythrocyte volume heterogeneity traditionally used in the classification of anemia (5).While RDW has been associated with adverse cardiovascular outcomes, the causal relationship remains uncertain (6). Pan et al. conducted a large population-based cohort study, integrating individual follow-up data and genetic analyses, to assess the prognostic and etiological roles of RDW in cardiovascular and metabolic diseases. Their findings confirmed strong associations between RDW and stroke, atrial fibrillation, heart failure, venous thromboembolism, diabetes, chronic kidney disease (CKD), and all-cause mortality. However, the absence of a significant association between genetically determined RDW and cardiovascular events suggests that RDW may act as a marker of systemic dysfunction rather than a direct causal factor. Notably, their observation of a negative correlation between RDW and diabetes, both phenotypically and in polygenic risk scores, challenges prior assumptions and calls for further mechanistic studies to elucidate the underlying biological pathways.Inflammation is a central driver of cardiovascular pathology, influencing the progression of atherosclerosis, heart failure, and thrombosis (7). Several systemic inflammatory markers have been proposed as potential predictors of adverse cardiovascular events. In a large-scale cross- Their study revealed a significant nonlinear association, with a threshold effect at an eGFR of 9.93. Below this threshold, each 10-unit increase in eGFR was associated with a 13% reduction in CVD risk, whereas above this threshold, no significant correlation was observed. These findings underscore the complex interplay between renal function, anemia status, and socioeconomic factors in cardiovascular risk stratification.These studies collectively highlight the dynamic evolution of blood biomarkers in cardiovascular research. Although biomarkers possess significant potential for diagnosis and prognosis, their successful clinical implementation demands careful attention to factors such as individual variability, assay standardization, and seamless integration with existing risk assessment models (9). Moving forward, research efforts should focus on validating biomarkers across diverse populations, delving into the mechanistic underpinnings of biomarker pathways, and conducting interventional trials to evaluate their therapeutic impact.As the field progresses toward precision medicine, the convergence of biomarker discovery with cutting-edge technologies-such as multi-omics profiling and artificial intelligenceoffers immense potential to revolutionize cardiovascular care. By honing biomarker-driven approaches, we can improve early detection, tailor treatments to individual needs, and ultimately elevate patient outcomes in the battle against cardiovascular disease (CVD).