Seeking and treating inflammation in ischaemic heart disease: are we ready?

Systemic inflammation, which contributes to atherosclerosis development and progression, plays a significant role in addressing the residual cardiovascular risk. Several studies have highlighted a linear correlation between high levels of the inflammation marker high-sensitivity C-reactive protein (hsCRP) and cardiovascular events. However, its use as a risk modifier remains debated, primarily due to its low specificity. The search for alternative systemic markers, such as interleukin-6 (IL-6), and signs of local inflammation, such as pericardial fat tissue, may provide improved prognostic tools. Computed tomography (CT)-positron emission tomography (PET) using 68Ga-DOTATATE, which binds to macrophage receptors, appears promising for identifying high-risk coronary lesions. Among invasive methods, optical coherence tomography is the only modality with sufficient resolution to study macrophages. Recent studies have shown how the regulation of inflammation may represent a new therapeutic strategy to safely reduce residual cardiovascular risk, particularly through molecules that inhibit microtubule formation and modulate IL-1α-1β signalling, IL-6, by lowering hsCRP values. The latest European Society of Cardiology guidelines recommended using colchicine in ischaemic heart disease with class IIA indication. However, the evidence of colchicine's efficacy in this context remains conflicting and inconclusive. In addition, using new systemic markers (IL-6) and modern non-invasive CT or CT-PET imaging techniques will lead to better accuracy in the diagnosis of inflammation, not only systemic but also organ- and lesion-specific.