Inflammation in atherosclerosis: a Big Idea that has underperformed so far

Area of Science:

• Cardiovascular Research
• Inflammation and Immunology
• Medical Technology

Background:

• Inflammation has long been a central concept in atherosclerosis research and therapeutic development.
• Recent clinical trials and analyses are re-evaluating the significance of inflammation in atherosclerotic cardiovascular disease (ASCVD).

Purpose of the Study:

• To assess the clinical performance of the inflammation concept in atherosclerosis.
• To identify novel therapeutic targets for early arterial disease.
• To review advancements in noninvasive imaging technologies for atherosclerosis.

Main Methods:

• Review of contemporary literature and recent clinical trial data.
• Analysis of hypotheses regarding residual ASCVD event risk.
• Discussion of emerging noninvasive arterial wall imaging technologies.

Main Results:

• Clinical trials cast doubt on the efficacy of colchicine, an approved anti-inflammatory agent for ASCVD.
• The hypothesis that residual ASCVD risk stems primarily from inflammation is challenged.
• Early intervention with lipid-lowering therapy and novel agents may be more effective than targeting inflammation in end-stage disease.

Conclusions:

• Advocates must provide convincing trial data to support the clinical value of inflammation in atherosclerosis.
• The focus on inflammation has potentially delayed earlier screening and treatment of arterial disease.
• Advancements in imaging are transforming atherosclerosis diagnosis and management, enabling focus on early, reversible disease.