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Inflammation in coronary atherosclerosis: diagnosis and treatment
Giovanni Occhipinti1, Salvatore Brugaletta2,3, Antonio Abbate4
1Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Catalunya, Spain.
Insights
Inflammation drives coronary atherosclerosis, from slow plaque growth to sudden heart attacks. Targeting this inflammation with new therapies offers a promising approach to managing coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Biomarkers
Background:
- Coronary atherosclerosis involves plaque buildup in arteries, linked to cholesterol and risk factors like smoking, diabetes, and hypertension.
- Systemic inflammation plays a critical role, influencing plaque progression from stable disease to acute coronary syndromes.
Purpose of the Study:
- To review inflammatory biomarkers and imaging for detecting inflammation in coronary plaque progression.
- To explore current and emerging anti-inflammatory therapies for coronary atherosclerosis.
Main Methods:
- Literature review of studies on inflammatory biomarkers in coronary atherosclerosis.
- Analysis of imaging techniques used to visualize arterial inflammation.
- Survey of clinical trials investigating anti-inflammatory drugs for cardiovascular disease.
Main Results:
- Inflammatory biomarkers and imaging are crucial for assessing plaque stage and risk.
- Existing anti-inflammatory drugs show some efficacy, with novel agents under investigation.
- Inflammation is a key therapeutic target in managing coronary artery disease.
Conclusions:
- Inflammation is central to coronary atherosclerosis, impacting plaque stability and clinical events.
- Biomarkers and imaging aid in risk stratification and treatment monitoring.
- Targeting inflammation represents a significant therapeutic strategy for preventing cardiovascular events.
Abstract:
Coronary atherosclerosis is a chronic condition characterised by the development of an atherosclerotic plaque in the inner layer of the coronary artery, mainly associated with cholesterol accumulation and favoured by endothelial dysfunction related to other cardiovascular risk factors, such as smoking, diabetes and hypertension. A key actor in this process is the systemic inflammatory response, which can make plaques either grow slowly over the course of years (like a 'mountain'), obstructing coronary flow, and causing stable coronary artery disease, or make them explode (like a 'volcano') with subsequent abrupt thrombosis causing an acute coronary syndrome. This central role of inflammation in coronary atherosclerosis has led to its consideration as a modifiable cardiovascular risk factor and a therapeutic target. Classic anti-inflammatory drugs have been tested in clinical trials with some encouraging results, and new drugs specifically designed to tackle inflammation are currently being under investigation in ongoing trials. The objectives of this review are to (1) summarise the role of inflammatory biomarkers and imaging techniques to detect inflammation at each stage of plaque progression, and (2) explore currently available and upcoming anti-inflammatory therapies.
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