Clinical approach to the inflammatory etiology of cardiovascular diseases

Area of Science:

• Cardiovascular Science
• Inflammation Research
• Pharmacology

Background:

• Inflammation is a key marker in arterial disease, influenced by cholesterol and molecular mechanisms.
• Understanding progenitor cell recruitment and clonal hematopoiesis enhances knowledge of inflammatory processes.
• High-sensitivity C-reactive protein (hsCRP) is a biomarker for cardiovascular (CV) risk, though not causative.

Purpose of the Study:

• To review the anti-inflammatory profiles of common cardiovascular preventive agents.
• To assess agents affecting lipids, blood pressure, diabetes, and nutraceuticals like n-3 fatty acids.
• To explore the relationship between risk factor modification and hsCRP changes.

Main Methods:

• Literature review of clinical trials and studies on anti-inflammatory agents in cardiovascular prevention.
• Analysis of the impact of various drug classes (statins, PCSK9 antagonists, ACE inhibitors, sartans, SGLT-2 inhibitors) and nutraceuticals on inflammation markers.
• Evaluation of biomarker changes, particularly hsCRP, in relation to cardiovascular risk reduction.

Main Results:

• Discordance observed between risk factor improvement and hsCRP reduction (e.g., statins vs. PCSK9 antagonists).
• Angiotensin-converting enzyme inhibitors show superior anti-inflammatory activity compared to sartans in hypertension.
• Icosapent ethyl demonstrated CV risk reduction in hypertriglyceridemia with a 27% decrease in hsCRP; SGLT-2 inhibitors' anti-inflammatory mechanisms remain unclear.

Conclusions:

• The inflammation-based approach to arterial disease is advancing with better diagnostic strategies and understanding of agent mechanisms.
• Agents targeting lipids, blood pressure, and diabetes possess varying anti-inflammatory effects.
• Nutraceuticals and specific agents like icosapent ethyl offer insights into managing inflammation-driven cardiovascular risk.