Beyond cholesterol: targeting inflammatory biomarkers in cardiovascular disease

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and increasing evidence has demonstrated that inflammation is a central driver of CVD initiation, progression, and clinical complications. While cholesterol-lowering therapies have transformed CVD prevention, a substantial residual inflammatory risk persists even in optimally treated patients, underscoring the need to move beyond lipid-centric paradigms. This narrative review synthesizes current knowledge on key inflammatory biomarkers including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO), and emerging multi-omics-derived signatures and examines their mechanistic roles in atherosclerotic plaque formation, endothelial dysfunction, and thromboinflammatory pathways. We highlight evidence from major clinical trials demonstrating that targeted modulation of inflammatory pathways, such as IL-1β inhibition and colchicine therapy, can reduce cardiovascular events independent of lipid lowering. Additionally, we discuss the translational challenges and opportunities in integrating inflammatory biomarkers into risk stratification, precision therapeutics, and clinical decision-making. By highlighting CVD as a lipid-inflammatory disorder, this review emphasizes the potential of inflammation-targeted strategies to complement existing therapies and reshape future cardiovascular prevention.