Aday Aaron W, Ridker Paul M
Divisions of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Center for Cardiovascular Disease Prevention, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.
Front Cardiovasc Med. 2018 Jun 5;5:62. doi: 10.3389/fcvm.2018.00062. eCollection 2018.
Inflammation is a critical pathway in the pathogenesis of atherosclerosis. Previous studies have shown that plasma levels of high-sensitivity C-reactive protein (hsCRP), a marker of inflammation, are associated with cardiovascular disease independent of traditional risk factors. Randomized trial data have also shown that statins reduce not only hsCRP but also cardiovascular event rates independent of their effect on low-density lipoprotein cholesterol (LDL-C) level. More recently, the CANTOS trial showed that directly reducing inflammation with canakinumab, an interleukin (IL)-1β neutralizing monoclonal antibody, could also reduce cardiovascular event rates. These mark the first phase 3 trial results validating inflammation as a viable target for preventing cardiovascular disease. In this review, we recap the role of inflammation in cardiovascular disease and highlight previous trial data showing its modulation with statins and other agents. We also detail the CANTOS trial results and discuss its implications for clinicians as well as future directions for anti-inflammatory therapy in the prevention of cardiovascular disease.
炎症是动脉粥样硬化发病机制中的关键途径。先前的研究表明，作为炎症标志物的高敏C反应蛋白（hsCRP）的血浆水平与心血管疾病相关，且独立于传统危险因素。随机试验数据还表明，他汀类药物不仅能降低hsCRP水平，还能降低心血管事件发生率，且与其对低密度脂蛋白胆固醇（LDL-C）水平的影响无关。最近，CANTOS试验表明，使用白细胞介素（IL）-1β中和单克隆抗体卡那单抗直接减轻炎症，也能降低心血管事件发生率。这些标志着首个验证炎症作为预防心血管疾病可行靶点的3期试验结果。在本综述中，我们概述炎症在心血管疾病中的作用，并强调先前显示他汀类药物和其他药物对其调节作用的试验数据。我们还详细介绍了CANTOS试验结果，并讨论其对临床医生的意义以及抗炎治疗在预防心血管疾病方面的未来方向。
