Clinical approach to the inflammatory etiology of cardiovascular diseases.

Abstract

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.

• Authors: Massimiliano Ruscica, Alberto Corsini, Nicola Ferri, Maciej Banach, Cesare R Sirtori
• Journal: Pharmacological research (Pharmacol Res) Vol. 159 Pg. 104916 (09 2020) ISSN: 1096-1186 [Electronic] Netherlands
• PMID: 32445957 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Anti-Inflammatory Agents
• Antihypertensive Agents
• Cardiovascular Agents
• Hypoglycemic Agents
• Hypolipidemic Agents
• Inflammation Mediators

Topics

• Animals
• Anti-Inflammatory Agents (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Cardiovascular Agents (therapeutic use)
• Cardiovascular Diseases (etiology, metabolism, physiopathology, prevention & control)
• Cardiovascular System (drug effects, metabolism, physiopathology)
• Diabetes Mellitus (drug therapy, metabolism, physiopathology)
• Dietary Supplements
• Dyslipidemias (drug therapy, metabolism, physiopathology)
• Gastrointestinal Microbiome
• Heart Disease Risk Factors
• Humans
• Hypertension (drug therapy, metabolism, physiopathology)
• Hypoglycemic Agents (therapeutic use)
• Hypolipidemic Agents (therapeutic use)
• Inflammation (drug therapy, etiology, metabolism, physiopathology)
• Inflammation Mediators (antagonists & inhibitors, metabolism)
• Risk Assessment
• Signal Transduction