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Published on: February 20, 2019
Recent Advances in Targeted Management of Inflammation In Atherosclerosis: A Narrative Review
Rafael Zubirán1, Edward B Neufeld1, Amaury Dasseux1
1Lipoprotein Metabolism Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Insights
Inflammation drives residual risk in atherosclerotic cardiovascular disease (ASCVD) even with cholesterol therapy. Targeting inflammation offers new therapeutic strategies for ASCVD patients.
Area of Science:
- Cardiology
- Immunology
- Biochemistry
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is a primary cause of death globally.
- Current therapies targeting low-density lipoprotein cholesterol (LDL-C) reduce ASCVD risk but do not eliminate it.
- Inflammation plays a significant role in the remaining, or residual, ASCVD risk.
Purpose of the Study:
- To review the role of inflammation in ASCVD progression and plaque stability.
- To explore inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP), for identifying residual risk.
- To propose novel therapeutic strategies targeting inflammation in ASCVD.
Main Methods:
- Literature review of studies on inflammation and ASCVD.
- Analysis of the biological mechanisms linking inflammation to atherosclerosis.
- Evaluation of current and potential future therapeutic targets for inflammation.
Main Results:
- Inflammation contributes to the development and instability of atherosclerotic plaques.
- Biomarkers like hsCRP can identify patients with an inflammatory ASCVD risk phenotype.
- Targeting inflammatory pathways presents a promising avenue for improving ASCVD outcomes.
Conclusions:
- Inflammation is a critical factor in residual ASCVD risk.
- hsCRP and other inflammatory markers can guide risk stratification and treatment.
- Developing inflammation-targeted therapies is essential for a new paradigm in ASCVD management.
Abstract:
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality despite effective low-density lipoprotein cholesterol-targeted therapies. This review explores the crucial role of inflammation in the residual risk of ASCVD, emphasizing its impact on atherosclerosis progression and plaque stability. Evidence suggests that high-sensitivity C-reactive protein (hsCRP), and potentially other inflammatory biomarkers, can be used to identify the inflammatory residual ASCVD risk phenotype and may serve as future targets for the development of more efficacious therapeutic approaches. We review the biological basis for the association of inflammation with ASCVD, propose new therapeutic strategies for the use of inflammation-targeted treatments, and discuss current challenges in the implementation of this new treatment paradigm for ASCVD.
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