Vascular dysfunction and translational biomarker discovery in stroke prevention

Stroke persists as a major global cause of death and disability, with its burden increasingly concentrated in low- and middle-income countries. Although acute treatments have improved, their limited applicability underscores an urgent need for more effective preventive strategies. This review focuses on the critical role of vascular dysfunction, a systemic process characterized by endothelial impairment, inflammation, and oxidative stress as a key precursor to stroke. We argue that advancing preventive medicine depends on the discovery of robust, mechanistic biomarkers that can identify subclinical vulnerability long before a stroke occurs, thereby improving early diagnosis and prognosis. Translational research models, including in vitro systems, animal models, and humanized platforms such as organ-on-a-chip devices, are indispensable for uncovering these biomarkers. They provide controlled settings for dissecting disease mechanisms, validating biomarkers, and testing targeted interventions. This review examines how such models bridge the gap between basic research and clinical application, ultimately supporting the development of personalized preventive approaches to reduce the growing global burden of stroke.