Ruscica Massimiliano, Corsini Alberto, Ferri Nicola, Banach Maciej, Sirtori Cesare R
Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy; Multimedica IRCCS, Milano, Italy.
Pharmacol Res. 2020 Sep;159:104916. doi: 10.1016/j.phrs.2020.104916. Epub 2020 May 20.
Inflammation is an obligatory marker of arterial disease, both stemming from the inflammatory activity of cholesterol itself and from well-established molecular mechanisms. Raised progenitor cell recruitment after major events and clonal hematopoiesis related mechanisms have provided an improved understanding of factors regulating inflammatory phenomena. Trials with inflammation antagonists have led to an extensive evaluation of biomarkers such as the high sensitivity C reactive protein (hsCRP), not exerting a causative role, but frequently indicative of the individual cardiovascular (CV) risk. Aim of this review is to provide indication on the anti-inflammatory profile of agents of general use in CV prevention, i.e. affecting lipids, blood pressure, diabetes as well nutraceuticals such as n-3 fatty acids. A crucial issue in the evaluation of the benefit of the anti-inflammatory activity is the frequent discordance between a beneficial activity on a major risk factor and associated changes of hsCRP, as in the case of statins vs PCSK9 antagonists. In hypertension, angiotensin converting enzyme inhibitors exert an optimal anti-inflammatory activity, vs the case of sartans. The remarkable preventive activity of SLGT-2 inhibitors in heart failure is not associated with a clear anti-inflammatory mechanism. Finally, icosapent ethyl has been shown to reduce the CV risk in hypertriglyceridemia, with a 27 % reduction of hsCRP. The inflammation-based approach to arterial disease has considerably gained from an improved understanding of the clinical diagnostic strategy and from a better knowledge on the mode of action of numerous agents, including nutraceuticals.
炎症是动脉疾病的一个必然标志，这既源于胆固醇本身的炎症活性，也源于已确立的分子机制。重大事件后祖细胞募集增加以及克隆性造血相关机制，使人们对调节炎症现象的因素有了更好的理解。针对炎症拮抗剂的试验促使人们对生物标志物进行了广泛评估，如高敏C反应蛋白（hsCRP），它虽不发挥因果作用，但常可指示个体心血管（CV）风险。本综述的目的是就心血管预防中常用药物（即影响血脂、血压、糖尿病的药物以及n-3脂肪酸等营养保健品）的抗炎特性提供指导。评估抗炎活性益处时的一个关键问题是，在对主要危险因素的有益作用与hsCRP的相关变化之间常常存在不一致，他汀类药物与前蛋白转化酶枯草溶菌素9（PCSK9）拮抗剂的情况就是如此。在高血压方面，血管紧张素转换酶抑制剂具有最佳抗炎活性，而沙坦类药物则不然。钠-葡萄糖协同转运蛋白2（SLGT-2）抑制剂在心力衰竭中的显著预防活性与明确的抗炎机制无关。最后，二十碳五烯酸乙酯已被证明可降低高甘油三酯血症患者的心血管风险，hsCRP降低了27%。基于炎症的动脉疾病研究方法，因对临床诊断策略的更好理解以及对包括营养保健品在内的众多药物作用方式的更深入了解而受益匪浅。
