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Published on: March 15, 2022
Anti-inflammatory interventions in coronary artery disease: antipodal responses requiring targeted therapeutic
Konstantinos Iliodromitis1,2, Melchior Seyfarth3,4, Zsuzsanna Balogh5
1Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Brusebrinkstrasse 20, 58135, Hagen, Germany. iliodromitis@evk-haspe.de.
Insights
Inflammation plays a dual role in coronary artery disease (CAD). While chronic inflammation requires suppression, acute myocardial infarction (MI) benefits from controlled inflammation for healing.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Pathophysiology
Background:
- Inflammation is integral to coronary atherosclerotic disease (CAD), influencing plaque development, progression, and instability.
- Chronic inflammation management is crucial for patients with cardiovascular risk and CAD.
- Acute myocardial infarction (MI) requires a controlled inflammatory response for healing and tissue repair.
Purpose of the Study:
- To review the multifaceted role of inflammation in both chronic and acute coronary artery disease (CAD).
- To discuss the pathophysiology underlying inflammation's impact on CAD and MI.
- To evaluate pharmaceutical strategies for modulating inflammatory responses in CAD and MI.
Main Methods:
- Review of experimental and clinical studies on inflammation in CAD and MI.
- Analysis of the pathophysiology of inflammatory processes in atherosclerotic disease.
- Examination of therapeutic interventions targeting inflammation in cardiovascular contexts.
Main Results:
- Nonselective anti-inflammatory drugs are ineffective and potentially harmful in MI.
- Excessive or prolonged inflammation post-MI can lead to irreversible myocardial damage.
- Selective anti-inflammatory agents may offer therapeutic benefits in specific MI scenarios.
Conclusions:
- Inflammation's role in CAD is context-dependent, necessitating distinct therapeutic approaches.
- Targeted anti-inflammatory strategies, particularly selective agents, show promise for managing detrimental inflammatory responses in MI.
- Further research into selective anti-inflammatory agents is warranted for optimizing outcomes in CAD and MI.
Abstract:
Inflammation has a key role in coronary atherosclerotic disease (CAD), as it contributes to the development, progression, instability and rupture of the atherosclerotic plaque. The long-term treatment and continuous suppression of inflammation is a therapeutic goal for patients with increased cardiovascular risk and chronic CAD syndromes. In contrast, in acute myocardial infarction (MI), the presence of inflammation is necessary for smooth healing, tissue neovascularization, and limitation of left ventricular remodeling, rendering a "controlled amount" of inflammation desirable in this context. As a result, the use of nonselective, broad-spectrum anti-inflammatory drugs does not offer any beneficial effect and may turn out to be harmful. Nevertheless, the possibility that modification of a usual inflammatory response in MI with selective anti-inflammatory agents cannot be excluded. Conversely, an excessive, uncontrolled, and prolonged inflammatory response after an acute MI may result in extensive irreversible myocardial damage and should be timely recognized and treated, preferably with a selective anti-inflammatory agent. In the present review we highlight the key role of inflammation in chronic and acute CAD, discuss the underlying pathophysiology, and present the results of representative experimental and clinical studies evaluating the pharmaceutical modification of the inflammatory response in this context.
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