A narrative review of drugs targeting inflammation in vascular disease

Area of Science:

• Cardiovascular Medicine
• Inflammation Research
• Pharmacology

Background:

• Inflammation is a key factor in atherosclerosis, increasing risks of myocardial infarction and stroke.
• Past anti-inflammatory drug trials for cardiovascular (CV) disease yielded inconsistent outcomes.
• Statins offer CV risk reduction via mechanisms beyond anti-inflammation.

Purpose of the Study:

• To review the evolving role of anti-inflammatory strategies in managing cardiovascular disease.
• To assess the efficacy of various anti-inflammatory agents targeting specific inflammatory pathways.
• To understand the challenges in utilizing inflammation as a target for cardiovascular risk reduction.

Main Methods:

• Review of historical and recent studies on anti-inflammatory drugs for cardiovascular risk.
• Analysis of drugs targeting broad vs. specific inflammatory pathways (e.g., NLRP3 inflammasome, IL-1β, IL-6).
• Examination of outcomes for agents like corticosteroids, methotrexate, and colchicine.

Main Results:

• Broad anti-inflammatory agents (corticosteroids, methotrexate) showed no CV benefit.
• Specific agents targeting NLRP3 inflammasome, IL-1β/IL-6, and hs-CRP have shown therapeutic promise.
• Recent data on colchicine introduced uncertainty regarding its routine CV risk reduction use.

Conclusions:

• Targeted anti-inflammatory approaches are crucial for significant cardiovascular event reduction.
• Our understanding of inflammation management for CV risk lags behind hypertension and dyslipidemia.
• Ongoing studies explore anti-cytokine agents to address residual cardiovascular risk.