IMR Press / RCM / Volume 24 / Issue 1 / DOI: 10.31083/j.rcm2401010
Open Access Review
Anti-Inflammatory Therapy in Coronary Artery Disease: Where Do We Stand?
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1 Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
2 Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
3 Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
4 Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia
5 Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
6 Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
*Correspondence: jelena.rakocevic@med.bg.ac.rs (Jelena Rakocevic)
These authors contributed equally.
Academic Editor: Brian Tomlinson
Rev. Cardiovasc. Med. 2023, 24(1), 10; https://doi.org/10.31083/j.rcm2401010
Submitted: 24 October 2022 | Revised: 17 November 2022 | Accepted: 24 November 2022 | Published: 4 January 2023
(This article belongs to the Special Issue Stress and Inflammation in Coronary Artery Disease)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Inflammation plays an important role in all stages of atherosclerosis — from endothelial dysfunction, to formation of fatty streaks and atherosclerotic plaque, and its progression to serious complications, such as atherosclerotic plaque rupture. Although dyslipidemia is a key driver of atherosclerosis, pathogenesis of atherosclerosis is now considered interplay between cholesterol and inflammation, with the significant role of the immune system and immune cells. Despite modern therapeutic approaches in primary and secondary cardiovascular prevention, cardiovascular diseases remain the leading cause of mortality worldwide. In order to reduce residual cardiovascular risk, despite the guidelines-guided optimal medical therapy, novel therapeutic strategies are needed for prevention and management of coronary artery disease. One of the innovative and promising approaches in atherosclerotic cardiovascular disease might be inflammation-targeted therapy. Numerous experimental and clinical studies are seeking into metabolic pathways underlying atherosclerosis, in order to find the most suitable pathway and inflammatory marker/s that should be the target for anti-inflammatory therapy. Many anti-inflammatory drugs have been tested, from the well-known broad range anti-inflammatory agents, such as colchicine, allopurinol and methotrexate, to targeted monoclonal antibodies specifically inhibiting a molecule included in inflammatory pathway, such as canakinumab and tocilizumab. To date, there are no approved anti-inflammatory agents specifically indicated for silencing inflammation in patients with coronary artery disease. The most promising results came from the studies which tested colchicine, and studies where the inflammatory-target was NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome/interleukin-1 beta (IL-1β)/interleukin-6 (IL-6)/C-reactive protein (CRP) pathway. A growing body of evidence, along with the ongoing clinical studies, suggest that the anti-inflammatory therapy might become an additional strategy in treating atherosclerotic cardiovascular disease. Herein we present an overview of the role of inflammation in atherosclerosis, the most important inflammatory markers chosen as targets of anti-inflammatory therapy, along with the critical review of the major clinical trials which tested non-targeted and targeted anti-inflammatory drugs in patients with atherosclerotic cardiovascular disease.

Keywords
coronary artery disease
inflammation
anti-inflammatory therapy
CRP
IL-6
IL-1β
canakinumab
tocilizumab
colchicine
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