Interplay between hypercholesterolaemia and inflammation in atherosclerosis: Translating experimental targets into clinical practice

J Tuñón, M Bäck, L Badimón… - European journal of …, 2018 - journals.sagepub.com
J Tuñón, M Bäck, L Badimón, ML Bochaton-Piallat, B Cariou, MJ Daemen, J Egido
European journal of preventive cardiology, 2018journals.sagepub.com
Dyslipidaemia and inflammation are closely interconnected in their contribution to
atherosclerosis. In fact, low-density lipoprotein (LDL)-lowering drugs have anti-inflammatory
effects. The Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) has
shown that interleukin (IL)-1β blockade reduces the incidence of cardiovascular events in
patients with previous myocardial infarction and C-reactive protein levels> 2 mg/L. These
data confirm the connection between lipids and inflammation, as lipids activate the Nod-like …
Dyslipidaemia and inflammation are closely interconnected in their contribution to atherosclerosis. In fact, low-density lipoprotein (LDL)-lowering drugs have anti-inflammatory effects. The Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) has shown that interleukin (IL)-1β blockade reduces the incidence of cardiovascular events in patients with previous myocardial infarction and C-reactive protein levels >2 mg/L. These data confirm the connection between lipids and inflammation, as lipids activate the Nod-like receptor protein 3 inflammasome that leads to IL-1β activation. LDL-lowering drugs are the foundation of cardiovascular prevention. Now, the CANTOS trial demonstrates that combining them with IL-1β blockade further decreases the incidence of cardiovascular events. However, both therapies are not at the same level, given the large evidence showing that LDL-lowering drugs reduce cardiovascular risk as opposed to only one randomized trial of IL-1β blockade. In addition, IL-1β blockade has only been studied in patients with C-reactive protein >2 mg/L, while the benefit of LDL-lowering is not restricted to these patients. Also, lipid-lowering drugs are not harmful even at very low ranges of LDL, while anti-inflammatory therapies may confer a higher risk of developing fatal infections and sepsis. In the future, more clinical trials are needed to explore whether targeting other inflammatory molecules, both related and unrelated to the IL-1β pathway, reduces the cardiovascular risk. In this regard, the ongoing trials with methotrexate and colchicine may clarify whether the cardiovascular benefit of IL-1β blockade extends to other anti-inflammatory mechanisms. A positive result would represent a major change in the future treatment of atherosclerosis.
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