The Emerging Role of Inflammation in Cardiovascular Disease

Area of Science:

• Cardiology
• Inflammation Research
• Pharmacology

Background:

• Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide.
• Elevated inflammatory markers, such as high-sensitivity C-reactive protein (hsCRP), are associated with increased ASCVD risk.
• Current ASCVD treatments primarily focus on lipid reduction and blood pressure control, with less emphasis on direct anti-inflammatory strategies.

Purpose of the Study:

• To review the role of inflammatory suppression in managing atherosclerotic cardiovascular disease (ASCVD).
• To evaluate the efficacy of canakinumab, an interleukin-1β (IL-1β) blocker, in reducing ASCVD events.
• To assess the impact of anti-inflammatory therapies on hsCRP levels and their correlation with ASCVD event reduction.

Main Methods:

• A comprehensive literature search was conducted using Ovid MEDLINE and other sources, covering studies from 1946 to February 2018.
• Search terms included inflammation, ASCVD, atherosclerosis, C-reactive protein, and canakinumab.
• English-language studies evaluating pharmacological agents' impact on hsCRP and ASCVD events were selected.

Main Results:

• Several drug classes, including aspirin, ACE inhibitors, gemfibrozil, and statins, reduce hsCRP to varying degrees and are linked to ASCVD event reduction.
• The Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) demonstrated a significant reduction in ASCVD events in patients with elevated hsCRP, independent of cholesterol levels.
• Canakinumab specifically targets the inflammatory pathway implicated in ASCVD.

Conclusions:

• Elevated hsCRP identifies patients at higher risk for ASCVD events.
• While various drugs lower hsCRP, canakinumab uniquely targets the inflammatory process in ASCVD.
• Canakinumab proved effective in preventing ASCVD events in patients with elevated hsCRP, highlighting the therapeutic potential of anti-inflammatory strategies.