IMMUNOMODULATORS IN THE TREATMENT OF ATHEROSCLEROSIS AND OTHER CHRONIC HEART DISEASES: PROSPECTS AND RISKS

Area of Science:

• Cardiovascular Medicine
• Immunology
• Pharmacology

Background:

• Atherosclerotic cardiovascular diseases are a leading global cause of death.
• Chronic inflammation drives disease progression, contributing to residual risk despite standard treatments.
• Novel immunomodulatory therapies are being investigated to address this unmet need.

Purpose of the Study:

• To systematically evaluate the efficacy and safety of immunomodulators in atherosclerosis and chronic cardiac diseases.
• To identify the therapeutic potential and associated risks of various immunomodulatory agents.
• To determine the clinical applicability of immunomodulators beyond traditional lipid-lowering therapies.

Main Methods:

• A comprehensive systematic literature search was conducted across major databases (Scopus, Web of Science, PubMed, Embase, Cochrane Library).
• 264 records were screened, with 74 studies (RCTs, reviews, cohort, retrospective, experimental) included in the qualitative synthesis.
• Study selection and synthesis followed PRISMA 2020 guidelines.

Main Results:

• Interleukin-1β inhibitors (canakinumab), small anti-inflammatory molecules (colchicine), and IL-6 receptor antagonists (tocilizumab) demonstrated cardiovascular benefits.
• Colchicine showed significant risk reduction (23-31%), while canakinumab reduced events by 15% and tocilizumab reduced infarct size by 12.4%.
• Biological agents, including canakinumab, were associated with increased infectious complications; colchicine presented an optimal efficacy-cost-safety profile.

Conclusions:

• Immunomodulatory therapy offers a transformative approach targeting inflammation in cardiovascular disease.
• Colchicine is a priority for clinical use due to its favorable profile, while biologics face economic and safety hurdles.
• Long-term surveillance of safety, especially infectious and oncological risks, is crucial for immunosuppressive therapies in diverse populations.