Biological Clues in a Silent Epidemic: Cardiovascular Disease Burden and the Role of Biological Markers

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, accounting for more than 20 million deaths annually and nearly one-third of all global deaths. The burden is disproportionately higher in low- and middle-income countries, including Sri Lanka, where rapid urbanization, demographic transition, and lifestyle changes have significantly increased disease prevalence. Despite major advances in pharmacological therapy, interventional cardiology, and preventive strategies, early detection remains suboptimal due to the silent and progressive nature of disease development. Biological markers, or biomarkers, have emerged as powerful tools for identifying subclinical disease, improving risk stratification, and enabling personalized therapeutic strategies. These markers provide insight into underlying pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and metabolic dysregulation. This oration explores the global and regional burden of cardiovascular disease, integrates findings from local research conducted in Sri Lanka, and discusses the evolving role of traditional and emerging biomarkers, particularly in acute coronary syndrome (ACS). Special emphasis is placed on oxidative stress and inflammatory biomarkers, their clinical relevance, and their potential to transform cardiovascular care from reactive treatment to preventive medicine.