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Systemic Review of Inflammatory Pathways and Immune Modulation in Atherosclerotic Cardiovascular Disease

Qian Wang1, Yi-Xuan Sui2, Le-Tong Zhang3

  • 1Cardiovascular Department, The Third Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China.

The American Journal of Cardiology
|August 16, 2025
PubMed

Insights

Targeted anti-inflammatory therapies, like interleukin-1 beta inhibitors and colchicine, show promise in preventing cardiovascular events beyond lipid reduction. Colchicine offers consistent benefits, even with low inflammation markers.

Area of Science:

  • Cardiovascular Medicine
  • Immunology
  • Pharmacology

Background:

  • Inflammation plays a key role in atherosclerotic cardiovascular disease (ASCVD).
  • Immune modulation offers potential benefits beyond traditional lipid-lowering therapies for ASCVD.
  • Residual inflammatory risk persists in many ASCVD patients despite optimal lipid management.

Purpose of the Study:

  • To systematically review inflammatory pathways and immunomodulatory therapies in ASCVD.
  • To evaluate the efficacy of targeted anti-inflammatory treatments in reducing cardiovascular events.
  • To identify promising therapeutic strategies for ASCVD prevention based on inflammatory markers.

Main Methods:

  • A PRISMA 2020-compliant systematic review of 57 studies (2000-2025).
  • Inclusion of randomized trials, observational cohorts, biomarker analyses, and genetic studies.
  • Evaluation of anti-inflammatory agents targeting pathways like Interleukin-1 beta (IL-1β) and Interleukin-6 (IL-6).

Main Results:

  • Interleukin-1 beta (IL-1β) inhibitors and colchicine consistently reduced major cardiovascular events.
  • Colchicine demonstrated efficacy even in patients with low C-reactive protein (CRP) levels.
  • Interleukin-6 (IL-6) inhibitors effectively suppressed biomarkers, but outcome data are pending.
  • Methotrexate showed no clinical benefit, and biologics had a modest risk of infection.

Conclusions:

  • Anti-inflammatory therapy is a promising adjunct for ASCVD prevention, particularly for patients with residual inflammatory risk.
  • Colchicine exhibits the most robust evidence for cardiovascular event reduction.
  • Further research is needed to define the role of IL-6 inhibition and personalized anti-inflammatory treatment strategies in ASCVD.

Keywords:
AtherosclerosisCardiovascular diseaseColchicineImmunomodulationInflammation

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