The primary prevention of CVD is dependent upon the ability to identify high-risk individuals long before the development of overt events. This highlights the need for biomarkers and accurate diagnosis. Despite an overwhelming number of individual biomarkers reported on cardiovascular disease, no one biomarker is found to be reliable in predicting or diagnosing a cardiovascular event.

The glycocalyx is an endothelial surface layer which lines the epithelial cells of the vascular system, protecting epithelial cells from vascular flow shear stress, coagulants and platelets, and leukocyte-cell interactions. Glycoproteins component of glycocalyx function as receptors on the cell surface, such as selectins, integrins, and members of the immunoglobulin superfamily; these are weaved into the net of the endothelial glycocalyx. Also, the endothelial surface layer consists of secreted proteoglycans (eg, versican and perlecan) and their adsorbed plasma proteins (eg, orosomucoid and albumin). Together with glycosaminoglycans (GAGs) and plasma proteins, the endothelial surface layer as a whole forms a dynamic barrier to circulating cells and soluble biologic macromolecules.

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The Glycocalyx is key to assessing, preventing and/or treating plaque formation leading to coronary heart disease (CHD).  The glycocalyx is now recognized as a key structure for maintaining vascular wall integrity.  Disruption or a decrease in thickness can result in chronic vascular disease; for example chronic stagnant blood flow, common in bifurcated sections of the arteries, triggers glycocalyx shedding and plaque formation.  When damaged, the glycocalyx sheds three components: syndecans, heparan sulfate, and hyaluronan.  Coincident to shedding is the release of plasminogen activator inhibitor–1 which is a potent inhibitor of fibrinolysis8.  Disturbance of the glycocalyx marks early stages of various clinical pathophysiologies including thrombus formation and atherscloerosis.