the PEGASUS trial but, in practice, we are still far away from having solid data on the required duration of anti-inflammatory treatment. Another question related to treatment modality is: at what stage of the disease acute or chronic would targeting inflammation be most beneficial?

Canakinumab was investigated only among patients who had experienced a documented MI at least 30 days before randomisation, whereas colchicine demonstrated its efficacy in those with acute MI as well as in patients with stable CAD.

While the role of combined lipid-lowering and anti-inflammatory therapy might become a cornerstone in the prevention and treatment of ASCVD, it is also prudent to promote lifestyle modification that might have anti-inflammatory potential.

Its physiological and transient elevation can be achieved by vigorous physical activity, intermittent fasting and dietary carbohydrate restriction.

However, time of initiation and duration of treatment have still to be determined. As discussed in this review, a large trial based on a 2 × 2 factorial design applying aggressive LDL-C lowering and aggressive anti-inflammatory anticytokine treatment to fully evaluate the potential additional value of reducing inflammation in the presence of ultra-low LDL-C concentrations may further optimise outcomes.

Moreover, it may be important to go beyond these targets and simultaneously address residual risk related to elevated triglycerides, elevated Lp a and thrombotic burden. This comprehensive approach to residual risk management has the potential to revolutionise the prevention of cardiovascular disease.

Nonetheless, we are still at the beginning of this journey with plenty of questions that need to be adequately addressed. ICR 3. ECR is the official journal of the. About ECR. Editorial Board. For Authors. Special Collections. Submit Article. Review Article. Natalie Arnold ,.

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Your rating Sign in to rate. Abstract Despite considerable advances in reducing the global burden of atherosclerotic cardiovascular disease by targeting conventional risk factors, significant residual risk remains, with low-grade inflammation being one of the strongest risk modifiers. Keywords Atherosclerosis , inflammation , dyslipidaemia , cardiovascular prevention , residual risk , novel treatment strategies ,.

Citation ×. Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks. Open Access: This work is open access under the CC-BY-NC 4. Atherosclerosis as an Interplay Between Lipoproteins and Inflammation: Biology and Mechanisms Canonically, atherosclerosis has been considered as a lipoprotein-driven disease, which is amplified and modified by the host immune cellular response to retained lipoproteins.

Inflammation as a Target for Intervention: Lipid-modifying and Anti-inflammatory Agents The initial evidence that systemic inflammation can be modified pharmacologically stems from the lipid-lowering trials of the early s, which demonstrated that statin therapy significantly reduced circulating levels of hsCRP, thereby confirming at least partially the interplay between inflammatory pathways and lipid metabolism.

Residual Cholesterol Versus Residual Inflammatory Risk: Rationale Applying a 2 × 2 Factorial Design for a Trial As discussed, lipoprotein metabolism and low-grade inflammation are interrelated in their contribution to atherogenesis.

Which Compounds to Select? Which Patients Might Benefit Most? Dhindsa DS, Sandesara PB, Shapiro MD, et al. The evolving understanding and approach to residual cardiovascular risk management.

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Endocrinology ;— Peter Libby, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. Paul Ridker. Inflammation is part of the body's natural response to protect itself against harm. There are two types: acute and chronic. The acute type occurs when you have an injury or infection.

This short-lived reaction rids the body of harmful intruders and repairs damaged cells. Chronic inflammation, on the other hand, can develop as a response to long-term exposure to unwanted substances in the body, such as toxins from cigarette smoke or an excess of fat tissue, especially around the midriff.

Chronic inflammation is important to heart health because it plays a pivotal role in the development of atherosclerosis — the buildup of fatty, cholesterol-rich plaque inside the arteries.

Your body perceives this plaque as foreign, so it initiates an inflammatory response to contain the damage. Chemical messengers called cytokines draw white blood cells to the area to consume the cholesterol particles and to wall off the plaque from the flowing blood.

But if that wall breaks down, the plaque may rupture. The contents then mingle with blood, forming a clot that could block blood flow. These clots are responsible for most heart attacks and strokes. The more than 10, patients enrolled in the CANTOS trial had already suffered a heart attack.

They also had high levels of C-reactive protein, a biomarker signaling bodywide inflammation see "What your CRP test results mean". All were taking standard heart drugs, but some also took varying doses of the drug canakinumab Ilaris. Canakinumab was not originally developed as a heart medicine; it's a specialized monoclonal antibody used to treat a rare autoimmune disorder in children.

It disrupts the inflammatory process by neutralizing a specific cytokine that is instrumental in the progression of atherosclerosis. This held true even though the canakinumab did not lower lipid levels or affect any other traditional heart risk factor, says Dr.

Your liver makes C-reactive protein CRP in response to inflammation. Low levels of this protein indicate the subtle, chronic inflammation that reflects unhealthy changes in artery walls.

Doctors check for CRP levels using a high-sensitivity C-reactive protein hsCRP test, which requires only a small amount of blood. The results signal three categories of risk:. It will probably take months for the CANTOS results to make their way into clinical practice, Dr.

Libby predicts. Canakinumab is already approved for other populations, but it has some notable side effects, including a greater risk of serious infections.

In the meantime, another study is testing the effectiveness of low-dose methotrexate in cardiovascular disease. In contrast to canakinumab, methotrexate is a generic, inexpensive drug commonly used to treat rheumatoid arthritis.

Results from this trial, also led by Dr. Ridker, should be available within the next few years. Research suggests that among people with normal cholesterol, those with increased CRP levels have several times the risk of heart problems compared with those who have low CRP. Until now, many doctors have been reluctant to recommend CRP testing as part of routine care because they believed the results wouldn't have an effect on treatment choices.

However, new drug therapies that specifically target cardiovascular inflammation will open the door to wider use of CRP testing, Dr.

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This report will examine the role that chronic inflammation plays in these conditions, and will also provide information on the breadth of drugs currently available to alleviate symptoms.

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Choose the right anti-inflammatory foods , and you may be able to reduce your risk of illness. Consistently pick the wrong ones, and you could accelerate the inflammatory disease process. Not surprisingly, the same foods on an inflammation diet are generally considered bad for our health, including sodas and refined carbohydrates, as well as red meat and processed meats.

Hu says. Unhealthy foods also contribute to weight gain, which is itself a risk factor for inflammation. Yet in several studies, even after researchers took obesity into account, the link between foods and inflammation remained, which suggests weight gain isn't the sole driver.

An anti-inflammatory diet should include these foods:. On the flip side are beverages and foods that reduce inflammation, and with it, chronic disease, says Dr. He notes in particular fruits and vegetables such as blueberries, apples, and leafy greens that are high in natural antioxidants and polyphenols — protective compounds found in plants.

Studies have also associated nuts with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes. Coffee , which contains polyphenols and other anti-inflammatory compounds, may protect against inflammation, as well.

To reduce levels of inflammation, aim for an overall healthy diet. When atherosclerosis becomes severe, a blood clot may form, or the artery may become blocked entirely. A blood clot or a blockage can result in a stroke or a heart attack. The type of food you consume affects the inflammation in your body and may help decrease the progression of atherosclerosis.

Eating anti-inflammatory foods helps to decrease inflammation, whereas eating pro-inflammatory foods increases inflammation in the body. Anti-inflammatory foods are rich in antioxidants, vitamins, fiber, flavonoids, carotenoids, and omega-3 fatty acids. Some examples are leafy green vegetables, olive oil, fatty fish, fruits, whole grains, and nuts.

Pro-inflammatory foods include processed foods, high-sugar foods, trans fat, and sugar-sweetened beverages and should be avoided or consumed in moderation. Although eating individual anti-inflammatory foods is great, adopting an anti-inflammatory diet, such as the Mediterranean diet, will benefit you even more in reducing inflammation.

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