Inflammation and Atherosclerosis
The End of a Controversy
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Does inflammation matter in coronary artery disease? Is it a driving force in atherosclerosis or merely an epiphenomenon? Is there space for novel therapies besides those targeting cholesterol? The CANTOS trial (Canakinumab Anti-inflammatory Thrombosis Outcomes Study), which was presented at the European Society of Cardiology meeting in Barcelona a few weeks ago, provides answers to these important questions. Indeed, the results of this trial open up a new avenue for cardiovascular prevention.
Atherosclerosis, the underlying pathology in most cases of myocardial infarction, ischemic stroke, and ischemic gangrene, is a disease of complex genesis that has remained controversial for decades. Clinical and experimental studies have provided unequivocal evidence for an etiologic role of cholesterol and also offered strong support for a pathogenic role of inflammation.1
By targeting cholesterol, blood pressure, and cigarette smoking, cardiovascular prevention has become one of the great success stories in medicine. We have witnessed a reduction in the incidence of myocardial infarction by ≈40% in large parts of the world during the past 2 decades, and a substantial part of this decrease can be ascribed to preventive medicine.1 Cholesterol-lowering statin therapy reduces the incidence of major adverse cardiovascular events by 25% to 50% in individuals with elevated low-density lipoprotein cholesterol and has become standard therapy for …