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Chronic Inflammatory Diseases and Cardiovascular Risk: Current Insights and Future Strategies for Optimal Management
Stefano Cacciatore1,2, Silvia Andaloro3, Marco Bernardi4
1Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
Insights
Chronic inflammation significantly increases cardiovascular disease (CVD) risk, especially in patients with inflammatory conditions. Current risk scores are inadequate, necessitating new strategies for better cardiovascular risk assessment and management.
Area of Science:
- Cardiology
- Immunology
- Inflammation Research
Background:
- Chronic inflammation is a key factor in atherosclerosis and cardiovascular disease (CVD) progression.
- Patients with chronic inflammatory diseases (e.g., IBD, rheumatological, autoimmune disorders) face higher risks of major adverse cardiac events (MACEs).
- Current cardiovascular risk (CVR) assessment tools often underestimate risk in these populations.
Purpose of the Study:
- To examine the link between chronic inflammation, immunomodulation, atherosclerosis, thrombosis, and cardiovascular events.
- To review epidemiological and clinical trial data on anti-inflammatory and immunomodulatory therapies for CVD.
- To identify knowledge gaps and propose future research directions for improved CVR management in chronic inflammatory diseases.
Main Methods:
- Narrative review of physiopathological mechanisms.
- Analysis of epidemiological studies and clinical trials.
- Exploration of anti-inflammatory and immunomodulatory treatment effects on cardiovascular outcomes.
Main Results:
- Chronic inflammation, immunomodulation, and atherosclerosis are interconnected pathways leading to cardiovascular events.
- Evidence suggests potential cardiovascular benefits from anti-inflammatory and immunomodulatory therapies.
- Existing CVR scores are insufficient for accurately assessing risk in patients with chronic inflammatory conditions.
Conclusions:
- There is a critical need for improved cardiovascular risk stratification in patients with chronic inflammatory diseases.
- Future research should focus on novel biomarkers (lipidomics, proteomics, inflammatory markers, microbiota) and advanced imaging.
- Tailored interventions are essential to optimize cardiovascular outcomes in this high-risk group.
Abstract:
Chronic inflammation is a pivotal driver in the progression of atherosclerosis, significantly contributing to the burden of cardiovascular disease (CVD). Patients with chronic inflammatory diseases, such as inflammatory bowel diseases (IBDs) (e.g., ulcerative colitis and Crohn's disease), rheumatological disorders, as well as individuals with auto-immune diseases (such as systemic lupus erythematosus), present a higher risk of major adverse cardiac events (MACEs). Despite their elevated CVD risk, these populations remain underrepresented in cardiovascular research, leading to a critical underestimation of their cardiovascular risk (CVR) in clinical practice. Furthermore, even recent CVR scores poorly predict the risk of events in these specific populations. This narrative review examines the physiopathological mechanisms linking chronic inflammation, immunomodulation, atherosclerosis, thrombosis and cardiovascular events. We review data from epidemiological studies and clinical trials to explore the potential cardiovascular benefits of anti-inflammatory and immunomodulatory therapies. Despite existing evidence, significant gaps in knowledge remain. Future research is mandatory, focusing on innovative strategies for risk stratification and optimization, including lipidomics, proteomics, advanced inflammatory markers, microbiota profiling, and cardiovascular imaging. Addressing these unmet needs will enhance understanding of cardiovascular risk in chronic inflammatory diseases, enabling tailored interventions and better outcomes.
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