Inflammation Emerging as a Central Factor in Cardiovascular Risk
Inflammation Emerging as a Central Factor in Cardiovascular Risk
Highlighted Expert Commentary.Date: June 3, 2025
Expert: Dr. Paul Ridker
Affiliation: Harvard Medical School / Brigham and Women’s Hospital
Topic: Inflammation and Heart Disease: A Paradigm Shift in Cardiovascular Risk Assessment
Key Highlights:
1. Shift in Focus
• Inflammation, not just cholesterol, is now a major focus in preventing and managing cardiovascular disease.
2. Role of hs-CRP
• High-sensitivity C-reactive protein (hs-CRP) is a strong, validated biomarker for coronary inflammation.
• It outperformed LDL and lipoprotein(a) in long-term cardiovascular risk prediction, as shown in the 30-year Women’s Health Study published in The New England Journal of Medicine.
3. Clinical Implications
• Ignoring inflammation may lead to missed opportunities for early intervention.
• Routine screening for LDL, hs-CRP, and Lp(a) is now encouraged in both primary and secondary prevention.
4. Therapeutic Advances
• Colchicine was FDA-approved in 2023 to treat coronary inflammation.
• Newer drugs like GLP-1 RAs and SGLT-2 inhibitors also reduce CRP levels.
• Ongoing trials are testing IL-6 inhibitors and other targeted agents (e.g., NLRP3-IL1-IL6 axis).
5. Imaging Innovations
• Fat attenuation index via cardiac CT enables direct imaging of perivascular coronary inflammation.
• This complements blood markers by localizing inflammation specifically to the coronary arteries.
6. Accessible Prevention Strategy
• Dr. Ridker advocates for a simple, cost-effective screening approach:
LDL + CRP + Lp(a), combined with history and physical exam.
• Recommends family cascade screening if elevated markers are detected.
7. Bottom Line
• A new paradigm in cardiovascular prevention is emerging—inflammation must be routinely assessed and treated, not just cholesterol.
