The role of visfatin as a biomarker in cardiovascular disease: a systematic review of its predictive and diagnostic potential

Cardiovascular diseases (CVDs) remain the leading global cause of morbidity and mortality, highlighting the need for novel biomarkers to improve early detection and risk stratification. Visfatin, an adipokine involved in inflammation and metabolic regulation, has emerged as a promising candidate due to its links with endothelial dysfunction and vascular remodeling. Following PRISMA guidelines, we systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar up to March 2025 using predefined search strings combining visfatin, nicotinamide phosphoribosyltransferase, cardiovascular disease, and biomarker terms. Of 543 records identified, 8 observational studies ( n = 1044 participants) were included. The Newcastle–Ottawa Scale was used for quality appraisal; a narrative synthesis was performed due to heterogeneity. Elevated visfatin was consistently associated with early vascular damage (hypertension, coronary slow-flow, obstructive sleep apnea in atrial fibrillation [AF]) and adverse prognostic outcomes (AF recurrence, left-ventricular hypertrophy, survival post-cardiac arrest). However, findings were derived solely from small, heterogeneous observational studies, with no randomized or interventional evidence. Current evidence suggests that visfatin may be a potential diagnostic and prognostic biomarker in CVD; however, the results are exploratory and hypothesis-generating. Standardized assays, larger multicenter cohorts, and head-to-head comparisons with established biomarkers, such as cardiac troponin (troponin), B-type natriuretic peptide, and C-reactive protein, are required before clinical translation.