Summary: Inflammation Emerging as a Central Target in Cardiovascular Risk Assessment
Summary: Inflammation Emerging as a Central Target in Cardiovascular Risk Assessment
Source: Interview with Dr. Paul Ridker,Harvard Medical School & Brigham and Women’s Hospital , announced on June 3, 2025.
Background: Dr. Paul Ridker, a leading expert in cardiovascular prevention, holds the Eugene Braunwald Professorship of Medicine at Harvard Medical School—an academic title named in honor of the legendary cardiologist and author of Braunwald’s Heart Disease.
He is widely known for pioneering the “inflammation hypothesis” in heart disease and for leading two landmark clinical trials:
• JUPITER (2008): Demonstrated the benefit of statins in patients with elevated hs-CRP but normal LDL.
• CANTOS (2017): Provided the first direct evidence that targeting inflammation (IL-1β) reduces cardiovascular events independently of lipid levels.
Key Highlights:
1. Paradigm Shift Toward Inflammation
• Inflammation is now recognized alongside cholesterol as a major contributor to atherosclerotic cardiovascular disease (ASCVD).
• High-sensitivity C-reactive protein (hs-CRP) is a validated biomarker for vascular inflammation and long-term risk.
2. CRP Surpassing Cholesterol as a Predictor
• Long-term data from the Women’s Health Study showed hs-CRP outperformed LDL and Lp(a) in predicting cardiovascular events.
• Early identification of inflammation-based risk may allow for preventive intervention decades before clinical manifestation.
3. Call for Routine Inflammatory Screening
• Dr. Ridker recommends universal testing for LDL, hs-CRP, and Lp(a) in both primary and secondary prevention.
• Quote: “Doctors won’t treat what they don’t measure.”
4. Pharmaceutical Advancements
• Colchicine became the first anti-inflammatory drug approved by the FDA in 2023 for coronary inflammation.
• Other drug classes with anti-inflammatory effects include GLP-1 receptor agonists and SGLT-2 inhibitors.
• Ongoing trials are targeting the NLRP3–IL-1–IL-6 inflammatory axis in CAD, HFpEF, and CKD.
5. Emerging Role of Imaging
• Cardiac CT with fat attenuation index enables direct visualization of coronary inflammation.
• More research is needed before adopting this imaging tool into routine practice.
6. Simplified, Cost-effective Prevention Strategy
• A practical approach includes: medical history, physical exam, and 3 blood tests (LDL, hs-CRP, Lp(a)).
• Family cascade screening is recommended when elevated inflammatory or lipid markers are found.
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Conclusion:
Inflammation is now a validated, actionable target in cardiovascular prevention—no longer secondary to cholesterol. With expanded biomarker testing, novel therapies, and imaging innovations, clinicians are encouraged to incorporate inflammation into routine risk assessment to enable earlier intervention and improved long-term outcomes.