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Current Atherosclerosis Reports

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01-11-2020 | Colchicine | Nonstatin Drugs (M. Vrablik, Section Editor)

Targeting Inflammation to Reduce Residual Cardiovascular Risk

Authors: Oluremi N. Ajala, Brendan M. Everett

Published in: Current Atherosclerosis Reports | Issue 11/2020

Abstract

Purpose of Review

Patients with established cardiovascular disease are at high risk for recurrent myocardial infarction, stroke, and cardiovascular death. The term residual risk refers to this risk that persists, even after optimal treatment. Considerable progress has been made to understand the biological basis of residual risk and to devise therapies that can safely and effectively reduce risk. The presence of ongoing subclinical vascular inflammation is known to be a marker of elevated residual risk, and reductions in measures of vascular inflammation predict improved outcome in these patients.

Recent Findings

Recent trials of anti-inflammatory agents have specifically tested the hypothesis that inflammation reduction reduces residual cardiovascular risk. Most prominent among these are the CANTOS, COLCOT, and CIRT trials. CANTOS enrolled patients with prior myocardial infarction (MI) and a high-sensitivity C-reactive protein ≥ 2 mg/L and reported a 15% reduction in major adverse cardiovascular events (MACE; HR 0.85, 95% CI 0.74–0.98) with the interleukin-1β inhibitor canakinumab. In COLCOT, colchicine 0.5 mg daily led to a 23% relative risk reduction (HR 0.77, 95% CI 0.61–0.96) in major vascular events in patients with recent acute coronary syndrome. By contrast, CIRT was stopped early for lack of benefit of low-dose methotrexate in preventing MACE in patients with coronary artery disease and either type 2 diabetes or the metabolic syndrome.

Summary

Ongoing subclinical inflammation is an important marker of risk in patients with established cardiovascular disease, and novel therapies targeted at specific inflammatory pathways now demonstrate efficacy for the prevention of major adverse cardiovascular events.

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Title: Targeting Inflammation to Reduce Residual Cardiovascular Risk
Authors: Oluremi N. Ajala
Brendan M. Everett
Publication date: 01-11-2020
Publisher: Springer US
Keywords: Colchicine
Myocardial Infarction
Arterial Occlusive Disease
Published in: Current Atherosclerosis Reports / Issue 11/2020
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-020-00883-3

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