[Anti-inflammatory treatment strategies in coronary heart disease].

BACKGROUND

Despite advances in lipid-lowering, antithrombotic, and interventional therapies, coronary heart disease (CHD) remains associated with a substantial risk of recurrent cardiovascular events. Inflammation has emerged as a major contributor to this residual risk. Experimental and clinical evidence indicates that inflammatory pathways, particularly activation of the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome and, downstream, the interleukin-1β-interleukin-6-C-reactive protein (CRP) axis, play a key role in atherosclerotic plaque progression and destabilization.

OBJECTIVES

This review summarizes the clinical evidence for anti-inflammatory therapies in patients with CHD.

CURRENT DATA: The CANTOS trial provided the first evidence that inhibition of interleukin-1β in CHD patients with elevated CRP reduces major adverse cardiovascular events independently of lipid lowering. Low-dose colchicine significantly reduced cardiovascular events in several trials, both early after myocardial infarction and in patients with chronic coronary disease.

CONCLUSIONS

These findings establish inflammation as a modifiable therapeutic target in the secondary prevention of CHD and support colchicine as the most advisable anti-inflammatory treatment currently available for CHD.