Inflammation and atherosclerotic cardiovascular disease: lights and shadows.

摘要

Atherosclerosis as an inflammatory process has been a Leitmotiv in cardiology for the past 30 years, and the hypothesis of a causal role has now been tested in several clinical trials aimed at demonstrating that drugs that primarily target inflammation can reduce cardiovascular events. Inflammation indeed drives all phases of atherosclerosis, from inception, through progression, and ultimately acute thrombotic complications triggered by plaque rupture and plaque erosion. Since atherothrombosis causes most acute myocardial ischaemic syndromes, appropriate anti-inflammatory treatments should limit the occurrence of such events and, consequently, of cardiovascular death. Such treatments might also reduce the propensity to thrombosis once the trigger (plaque rupture or erosion) has occurred. This brief review will summarise the main concepts, initial results and current expectations in this rapidly evolving area of cardiology, borrowing concepts and drugs from immunology and rheumatology. This is an extremely attractive, but still incomplete story, with still many challenges and shadows.