Biomarkers and Social Determinants in atherosclerotic Arterial Diseases: A Scoping Review.

Abstract

Background: Arterial diseases like coronary artery disease, carotid stenosis, peripheral artery disease, and abdominal aortic aneurysm have high morbidity and mortality, making them key research areas. Their multifactorial nature complicates patient treatment and prevention. Biomarkers offer insights into the biochemical and molecular processes, while social factors also significantly impact patients' health and quality of life. This scoping review aims to search the Literature for studies that have linked the biological mechanisms of arterial diseases through biomarkers with social issues and to analyze them, supporting the interdependence of biological and social sciences.

Methods: After a rigorous selection process, adhering to the PRISMA Guidelines for Scoping Reviews, 30 articles were identified through Scopus, Web of Science, and PubMed. Inclusion and exclusion criteria were based on the PICOTS (population, intervention, comparator, outcome, time, and setting) framework. Inclusion criteria were studies involving human subjects that explored the relationships between arterial diseases, biomarkers, and psychosocial factors, with no restrictions on publication date. Non-human studies, purely biological or medical analyses without psychosocial dimensions, and non-English publications were excluded. Eligible study types included experimental, observational, and review articles published in peer-reviewed journals. Data extraction focused on study characteristics, such as authors, publication year, country, methods, population, and findings. Results were synthesized narratively, as this format was deemed the most suitable for summarizing diverse findings. The quality or methodological rigor of the included studies was not formally assessed, consistent with the scoping review methodology.

Results: In coronary artery disease, biomarkers such as high-sensitivity C-reactive protein are strongly associated with psychological stress, whereas lipoprotein(a) and the Apolipoprotein B/Apolipoprotein A1 ratio reflect lipid profiles that are influenced by socioeconomic factors and ethnicity. In carotid stenosis, increased carotid intima-media thickness is linked to psychiatric conditions like Attention Deficit/Hyperactivity Disorder, and heat shock protein-70 levels are associated with socioeconomic status and gender. In peripheral artery disease, inflammatory markers, including interleukin-6, intracellular adhesion molecule-1, and high-sensitivity C-reactive protein, mediate the connection between depression and disease severity, with gender and ethnicity influencing the expression of biomarkers and clinical outcomes. In abdominal aortic aneurysm, factors like smoking and exposure to air pollution have increased matrix metalloproteinase (MMP-2) levels and other inflammatory markers. Additionally, estradiol provides partial protection in women, underscoring the role of hormones and environmental influences in disease progression. Social determinants such as socioeconomic status, healthcare access, and ethnicity significantly affect biomarker levels and arterial disease progression.

Conclusions: These findings are crucial for the assumption that social determinants of health modulate the levels of inflammatory biomarkers involved in the progression of arterial diseases such as coronary artery disease, carotid stenosis, peripheral artery disease, and abdominal aortic aneurysm. This highlights the need to integrate highly predictive mathematical systems into clinical practice, combining biological sciences with social sciences to achieve advanced standards in precision medicine. However, further studies are needed to validate these approaches fully.