Myeloperoxidase (MPO), a heme-containing protein integral to the innate immune system, plays a pivotal role in both bactericidal activity and inflammation regulation. In this comprehensive review, we aim to delve into the extensive literature on MPO’s involvement in cardiovascular disease. Through exhaustive searches of reputable databases such as PubMed, Scopus, and Web of Science, we conducted a thorough analysis to elucidate MPO’s potential as a predictor for cardiovascular disease risk. Evidence suggests that MPO serves as a valuable biomarker, particularly in identifying vulnerable lesions predisposed to rupture,leading to myocardial infarction, especially in the context of acute coronary syndrome. Its early release in response to symptom onset positions MPO as a promising tool for triaging chest pain patients in emergency departments, offering advantages over conventional markers like cardiac troponins. Moreover, studies have demonstrated a correlation between elevated MPO levels and higher mortality rates in patients with acute coronary syndrome, both in short- and long-term follow-up. However, the widespread adoption of MPO as a routine clinical biomarker faces significant challenges. Standardizing measurement techniques and determining the optimal timing of assessments are crucial for ensuring reliability and comparability across studies. Furthermore, while MPO shows promise as a complement to existing risk stratification protocols, questions remain regarding its superiority over troponins and its utility in stable coronary artery disease. Addressing these issues necessitates large-scale prospective cohort studies to clarify MPO’s comparative effectiveness alongside conventional biomarkers. Despite these challenges, MPO emerges as a potentially valuable addition to risk assessment strategies, particularly for patients with persistently negative troponin levels, helping guide therapeutic interventions and enhancing clinical decision-making in cardiovascular medicine.
