Residual Inflammatory Risk in Atherosclerotic Cardiovascular Disease: Is Anti-Inflammatory Therapy the Next Frontier Beyond LDL Reduction?

Authors

Keywords:

Atherosclerotic Cardiovascular Disease, Residual Inflammatory Risk, hsCRP, Colchicine, Canakinumab, Major Adverse Cardiovascular Events

Abstract

Background: 

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality around the world despite the present aggressive low density lipoprotein (LDL) lowering therapy. Elevated hsCRP levels reflects persistent vascular inflammation and this contributes to the residual inflammatory risk and recurrence in cardiovascular events even in the patients achieving optimal controlled lipid levels.

 

Objective:

The study aims to evaluate the efficacy of the anti inflammatory therapies aiming in reducing the residual inflammatory risk and cardiovascular events beyond LDL reduction in ASCVD.

 

Methodology:

This study analyses the efficacy of canakinumab and low dose colchicine. This is done by evaluating hsCRP reduction, major adverse cardiovascular events (MACE), myocardial infarction, stroke and all the recurrent coronary events through the landmark trials.

 

Results:

Patients having LDL level <70mg/dl demonstrated inflammatory risk with nearly 31% exhibiting elevated hsCRP levels. Canakinumab reduced hsCRP levels by upto 41% and lowered the incidence of recurrent cardiovascular events by 15%. Low dose colchicine accounted to 23-31% reduction in major cardiovascular events across the COLCOT AND LoDoCo2 trials. Studies show an overall 25% reduction in MACE with long term safety outcomes.

 

Conclusion:

Anti inflammatory therapy is a promising adjunctive strategy in managing ASCVD by targeting the residual inflammatory risk beyond the conventional lipid lowering approach. Therapies such as canakinumab and colchicine may redefine future cardiovascular prevention through its dual targeted approach that integrates lipid control and modulation of inflammation for improved long term cardiovascular outcomes.

References

Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, Fonseca F, Nicolau J, Koenig W, Anker SD, Kastelein JJP, Cornel JH, Pais P, Pella D, Genest J, Cifkova R, Lorenzatti A, Forster T, Kobalava Z, Vida-Simiti L, Flather M, Shimokawa H, Ogawa H, Dellborg M, Rossi PRF, Troquay RPT, Libby P, Glynn RJ; CANTOS Trial Group. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017 Sep 21;377(12):1119-1131. doi: 10.1056/NEJMoa1707914. Epub 2017 Aug 27. PMID: 28845751.

Aday AW, Ridker PM. Targeting Residual Inflammatory Risk: A Shifting Paradigm for Atherosclerotic Disease. Front Cardiovasc Med. 2019 Feb 28;6:16. doi: 10.3389/fcvm.2019.00016. PMID: 30873416; PMCID: PMC6403155.

Giubilato S, Ciliberti G, Scicchitano P, Di Monaco A, Fortuni F, Zilio F, Ciampi CM, Cangemi S, Spinelli A, Gatto L, Franchin L, Cornara S, Magnesa M, Sorini Dini C, Vitale E, Gasparetto N, Geraci G, Rossini R, Della Bona R, Nardi F, Gabrielli D, Gulizia MM, Grimaldi M, Oliva F, Imazio M. Colchicine and Atherosclerotic Coronary Artery Disease: An Updated Review. J Clin Med. 2025 Sep 10;14(18):6396. doi: 10.3390/jcm14186396. PMID: 41010600; PMCID: PMC12471264.

Peikert A, Kaier K, Merz J, Manhart L, Schäfer I, Hilgendorf I, Hehn P, Wolf D, Willecke F, Sheng X, Clemens A, Zehender M, von Zur Mühlen C, Bode C, Zirlik A, Stachon P. Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort. Clin Res Cardiol. 2020 Mar;109(3):315-323. doi: 10.1007/s00392-019-01511-0. Epub 2019 Jul 19. PMID: 31325043; PMCID: PMC7042185.

.

Samuel M, Berry C, Dubé MP, Koenig W, López-Sendón J, Maggioni AP, et al. Long-term trials of colchicine for secondary prevention of vascular events: a meta-analysis. European Heart Journal. 2025 Jul 7;46(26):2552–63. doi:10.1093/eurheartj/ehaf174

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Published

2026-08-19

How to Cite

Muraleedharan, T., Ammineni, K., Shah, P., & Srijamya. (2026). Residual Inflammatory Risk in Atherosclerotic Cardiovascular Disease: Is Anti-Inflammatory Therapy the Next Frontier Beyond LDL Reduction?. International Journal of Medical Students. Retrieved from https://ijms.pitt.edu/IJMS/article/view/4839

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Forthcoming

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Abstracts of the WCMSR

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Copyright (c) 2026 Tanishka Muraleedharan, Kavya Ammineni, Parth Shah, Srijamya

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