miRNAs in coronary artery disease pathophysiology: mechanisms and diagnostic perspectives

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, largely driven by atherosclerotic processes within the coronary arteries. Non-coding RNAs (ncRNAs), a diverse group that includes microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), have emerged as crucial regulators of cardiovascular biology. Among these, miRNAs are particularly well-studied for their ability to fine-tune gene expression and modulate key cellular events, such as inflammation, endothelial dysfunction, vascular remodeling, and apoptosis—all of which are central to CAD pathogenesis. This narrative review provides a comprehensive synthesis of the current evidence on the roles of miRNAs in CAD, emphasizing their mechanistic contributions and clinical potential as candidates for diagnosis and prognosis. The review also addresses the diagnostic performance of specific miRNAs, discusses their utility in distinguishing between stable CAD and acute coronary syndromes, and critically appraises methodological challenges such as study heterogeneity and lack of standardization. While miRNAs represent a promising frontier for improved risk stratification and targeted therapy in CAD, further research is needed to clarify their complex regulatory networks and translate these findings into clinical practice. The integration of miRNA research with broader ncRNA studies may ultimately enhance our understanding of CAD and foster the development of novel diagnostic and therapeutic strategies.