The role of inflammation and the possibilities of inflammation reduction to prevent cardiovascular events

Serban Maierean; Richard Webb; Maciej Banach; Mohsen Mazidi

doi:10.1093/ehjopen/oeac039

The role of inflammation and the possibilities of inflammation reduction to prevent cardiovascular events

Eur Heart J Open. 2022 Jun 14;2(4):oeac039. doi: 10.1093/ehjopen/oeac039. eCollection 2022 Jul.

Authors

Serban Maierean¹, Richard Webb², Maciej Banach³, Mohsen Mazidi⁴

Affiliations

¹ Department of Medicine, University of Toronto, Toronto, ON, Canada.
² Faculty of Science, Liverpool Hope University, Taggart Avenue, Liverpool, UK.
³ Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Rzgowska 281/289, Lodz 93-338, Poland.
⁴ Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Abstract

Chronic systemic inflammation is a risk factor for cardiovascular (CV) disease (CVD). Whether this relationship extends to subclinical inflammation, quantified by values of circulating markers associated with inflammation in the high range of the normal interval, remains debatable. This narrative review evaluates evidence exploring this relationship. A review of pharmacological and non-pharmacological interventions, including diet and lifestyle strategies, supplements, nutraceuticals, and other natural substances aimed at reducing inflammation was also conducted, since few reviews have synthesized this literature. PubMed and EMBASE were used to search the literature and several well-studied triggers of inflammation [oxidized LDL, Lp(a), as well as C-reactive protein (CRP)/high-sensitivity CRP (hs-CRP)] were included to increase sensitivity and address the lack of existing reviews summarizing their influence in the context of inflammation. All resulting references were assessed. Overall, there is good data supporting associations between circulating hs-CRP and CV outcomes. However, the same was not seen in studies evaluating triggers of inflammation, such as oxidized LDL or Lp(a). There is also insufficient evidence showing treatments to target inflammation and lead to reductions in hs-CRP result in improvements in CV outcomes, particularly in those with normal baseline levels of hs-CRP. Regarding pharmacological interventions, statins, bempedoic acid, and apabetalone significantly reduce circulating hs-CRP, unlike PCSK-9 inhibitors. A variety of natural substances and vitamins were also evaluated and none reduced hs-CRP. Regarding non-pharmacological interventions, weight loss was strongly associated with reductions in circulating hs-CRP, whereas various dietary interventions and exercise regimens were not, unless accompanied by weight loss.

Keywords: Cardiovascular disease; Inflammation; hs-CRP.

Publication types

Review