Clinical proteomics in cardiovascular medicine: Current capabilities, limitations, and future directions

BACKGROUND AND AIMS: Commercial high-throughput proteomics platforms, such as Olink and SomaLogic, enable large-scale epidemiological studies with integrated multi-omics measurements. While these proteomics approaches have been widely applied in biobanks, issues of data quality remain underappreciated. In this review, we discuss these limitations and outline a way forward for realizing the clinical translation of proteomics as a comprehensive 'liquid health check'. METHODS: We reviewed the recent literature for artificial intelligence (AI) and multi-omics, particularly proteomics in atherosclerotic cardiovascular disease (ASCVD). RESULTS: AI-driven multi-omics analyses have the potential to advance our understanding of multifactorial causes of ASCVD, including aging. Emerging concepts such as "ageotypes" suggest the potential for personalized intervention to slow aging processes. Commercial proteomics platforms have accelerated biomarker discovery in ASCVD, but challenges remain in clinical translation. Limited correlation between Olink and SomaLogic necessitates orthogonal validation of findings. Platform-specific issues, such as epitope effects and cross-reactivity, can yield divergent protein quantitative trait loci for the same protein, complicating causal inference. While tissue proteomics provides complementary insights to plasma proteomics, reliance on autopsy samples raises concerns about protein degradation and measurement reliability. Increasingly, single-cell and spatial proteomics are being explored to better capture plaque heterogeneity, complementing bulk proteomics in larger cohorts. CONCLUSION: Beyond risk prediction, proteomics offers opportunities to elucidate disease mechanisms and enable drug repurposing. To realize the clinical potential of plasma proteomics, absolute or reliably recalibratable relative quantification will be required to guide patient care. Ultimately, the clinical value of proteomics will be determined by the quality rather than the quantity of protein measurements.