Persistent inflammatory residual risk despite aggressive cholesterol-lowering therapy: what is next?

TY - JOUR

T1 - Persistent inflammatory residual risk despite aggressive cholesterol-lowering therapy: what is next?

AU - Arnold, Natalie

AU - Koenig, Wolfgang

N1 - Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - PURPOSE OF REVIEW: To briefly summarize recently published evidence on the possible therapeutic modulation of inflammatory processes in atherosclerotic cardiovascular disease (ASCVD), focusing on the rationale for an additional randomized clinical trial, targeting both persistently elevated cholesterol and inflammatory residual risk and critically discuss still open issues and future perspectives with regard to treatment allocation.RECENT FINDINGS: Several large-scale clinical trials over the past few years have advanced our understanding of the role of inflammation in atherosclerosis, demonstrating that targeting the NLRP3 inflammasome and the IL-1β pathway indeed represent a new avenue to reduce residual risk in patients with ASCVD. However, despite optimal lipid-lowering therapy and novel options to modulate residual inflammatory risk, there are still a large number of individuals, being at high risk for recurrent ASCVD events.SUMMARY: The integration of a dual target strategy aimed at lowering the inflammatory burden in combination with aggressive lipid-modifying for those at high/very high ASCVD risk may hold potential to significantly improve patient care. However, a number of questions related to the design of such 2 × 2 factorial trial still needs to be answered.

AB - PURPOSE OF REVIEW: To briefly summarize recently published evidence on the possible therapeutic modulation of inflammatory processes in atherosclerotic cardiovascular disease (ASCVD), focusing on the rationale for an additional randomized clinical trial, targeting both persistently elevated cholesterol and inflammatory residual risk and critically discuss still open issues and future perspectives with regard to treatment allocation.RECENT FINDINGS: Several large-scale clinical trials over the past few years have advanced our understanding of the role of inflammation in atherosclerosis, demonstrating that targeting the NLRP3 inflammasome and the IL-1β pathway indeed represent a new avenue to reduce residual risk in patients with ASCVD. However, despite optimal lipid-lowering therapy and novel options to modulate residual inflammatory risk, there are still a large number of individuals, being at high risk for recurrent ASCVD events.SUMMARY: The integration of a dual target strategy aimed at lowering the inflammatory burden in combination with aggressive lipid-modifying for those at high/very high ASCVD risk may hold potential to significantly improve patient care. However, a number of questions related to the design of such 2 × 2 factorial trial still needs to be answered.

KW - Atherosclerosis/drug therapy

KW - Cholesterol

KW - Humans

KW - Inflammation/drug therapy

KW - Randomized Controlled Trials as Topic

U2 - 10.1097/HCO.0000000000000909

DO - 10.1097/HCO.0000000000000909

M3 - SCORING: Review article

C2 - 34475328

VL - 36

SP - 776

EP - 783

JO - CURR OPIN CARDIOL

JF - CURR OPIN CARDIOL

SN - 0268-4705

IS - 6

ER -