# Diagnostic, Prognostic and Therapeutic Utility of MicroRNA-21 in Ischemic Heart Disease

## TL;DR

This paper reviews how microRNA-21 (miR-21) can help diagnose, predict outcomes, and treat ischemic heart disease by influencing key disease processes.

## Contribution

The paper provides a comprehensive review of miR-21's role in ischemic heart disease, emphasizing its dual therapeutic potential and limitations.

## Key findings

- MiR-21 is involved in endothelial dysfunction, inflammation, and plaque vulnerability in ischemic heart disease.
- Circulating miR-21 has diagnostic and prognostic value across different stages of ischemic heart disease.
- MiR-21 offers cardio protection in acute injury but may contribute to fibrosis if dysregulated.

## Abstract

Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality despite advances in prevention, diagnosis, and therapy. Traditional clinical risk scores and biomarkers often fail to fully capture the complex molecular processes underlying atherosclerosis, myocardial infarction, and ischemic cardiomyopathy, leaving substantial residual risk. MicroRNAs have emerged as promising regulators and biomarkers of cardiovascular disease, among which microRNA-21 (miR-21) has attracted particular attention. MiR-21 is deeply involved in key pathophysiological mechanisms of IHD, including endothelial dysfunction, vascular inflammation, vascular smooth muscle cell proliferation, plaque development and vulnerability, cardiomyocyte survival, and myocardial fibrosis. Accumulating clinical evidence suggests that circulating miR-21 holds diagnostic value across the ischemic continuum, from stable coronary artery disease to acute coronary syndromes, myocardial infarction, and ischemic heart failure. Moreover, miR-21 demonstrates prognostic relevance, correlating with plaque instability, adverse remodeling, heart failure progression, and long-term cardiovascular outcomes. Preclinical studies further indicate that miR-21 represents a double-edged therapeutic target, offering cardio protection in acute ischemic injury while contributing to fibrosis and maladaptive remodeling if dysregulated. This narrative review summarizes current evidence on the diagnostic, prognostic, and therapeutic utility of miR-21 in IHD, highlighting its clinical promise as well as key limitations and future translational challenges.