Targeting the residual cardiovascular risk by specific anti-inflammatory interventions as a therapeutic strategy in atherosclerosis

Abstract

Chronic subclinical inflammation is a key process in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Along with lipids, inflammation is essential for the initiation and progression of atherosclerosis with macrophages playing a pivotal role through the induction of oxidative stress and cytokine secretion. Several pro-inflammatory cytokines have been described in the primary and secondary prevention of ASCVD. Although extensive work over the past decades has established the role of lipid-lowering medications in the prevention and treatment of ASCVD, modulation of inflammation is a subject of active debate. It remains to be confirmed whether targeting the residual cardiovascular risk by adding anti-inflammatory agents to the conventional cardiovascular treatment becomes a shifting paradigm for ASCVD management. This review aims to discuss novel therapeutic agents targeting inflammatory pathways in ASCVD in light of the canakinumab anti-inflammatory thrombosis outcomes study (CANTOS) trial results. Further we discuss the effects of different anti-inflammatory agents administered in patients with ASCVD and their potential to change clinical practice in preventive cardiology.

Keywords: Anakinra (Compound CID: 139595263); Arglabin (PubChem CID: 636760); Atherosclerosis; Atorvastatin (PubChem CID: 60823); CANTOS; Canakinumab (Substance SID: 96025995); Cardiovascular disease; Colchicine (PubChem CID: 6167); Inflammation; MCC950 (Compound CID: 91826093); Methotrexate (PubChem CID: 126941); Miltefosine (PubChem CID: 3599); NLRP3 Inflammasome; Residual cardiovascular risk; Rilonacept (Substance SID: 440790923); Rosuvastatin (PubChem CID: 446157); Tocilizumab (Substance SID: 349016747); Ziltivekimab (Substance SID: 404719986).