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Inflammation and atherosclerotic cardiovascular disease: where do we go from here?

Ori Waksman1, Ron Waksman2

  • 1Section of Cardiology.

Current Opinion in Lipidology
|November 5, 2025
PubMed

Insights

Systemic inflammation, measured by high-sensitivity C-Reactive Protein (hsCRP), drives atherosclerotic cardiovascular disease (ASCVD). This review examines colchicine trials and novel anti-inflammatory therapies for cardiovascular prevention.

Area of Science:

  • Cardiology
  • Inflammation Biology
  • Pharmacology

Background:

  • Low-grade systemic inflammation, indicated by hsCRP, is a key factor in atherosclerotic cardiovascular disease (ASCVD) progression and major adverse cardiovascular events (MACE).
  • The recent FDA approval of colchicine for secondary cardiovascular prevention marked a milestone, but neutral trial outcomes have raised questions about its efficacy and the need for alternative anti-inflammatory strategies.
  • Growing understanding of inflammation's role in atherosclerosis necessitates updated management strategies and exploration of future therapeutic options.

Purpose of the Study:

  • To provide an updated summary of inflammation's role in ASCVD.
  • To review recent key clinical trials, including those involving colchicine, IL-1 antagonists, and IL-6 inhibitors.
  • To explore investigational anti-inflammatory treatments and discuss considerations for future clinical trial designs.

Main Methods:

  • Literature review of recent clinical trials and scientific publications.
  • Analysis of data from trials involving colchicine, IL-1 antagonists, and IL-6 inhibitors.
  • Discussion of underlying mechanisms of inflammation in ASCVD.

Main Results:

  • Recent trials involving colchicine have yielded mixed results, prompting re-evaluation of its efficacy in secondary cardiovascular prevention.
  • Interleukin-1 (IL-1) antagonists and interleukin-6 (IL-6) inhibitors represent emerging therapeutic targets for managing inflammation in ASCVD.
  • The review synthesizes findings from contemporary trials to inform current understanding of anti-inflammatory therapy effectiveness.

Conclusions:

  • Inflammation remains a critical target for ASCVD management, with ongoing research into novel anti-inflammatory agents.
  • Future research should focus on refining patient selection for anti-inflammatory therapies and designing trials to better elucidate treatment benefits.
  • Optimizing anti-inflammatory strategies is crucial for reducing MACE and improving outcomes in patients with ASCVD.
Abstract

Keywords:
cardiovascular diseasecolchicinehigh-sensitivity C-reactive proteininflammationresidual inflammatory risk

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