Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transl Med. Jan 31, 2019; 8(1): 1-8
Published online Jan 31, 2019. doi: 10.5528/wjtm.v8.i1.1
Inflammation and cardiovascular disease
Christina G Katsiari, Dimitrios P Bogdanos, Lazaros I Sakkas
Christina G Katsiari, Dimitrios P Bogdanos, Lazaros I Sakkas, Department of Rheumatology and Clinical Immunology, Division of Medicine, University of Thessaly, Larissa 41110, Greece
Author contributions: Katsiari CG, Bogdanos DP and Sakkas LI conceived the study and drafted the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lazaros I Sakkas, Professor, FRCP (Hon), MD, PhD, Department of Rheumatology and Clinical Immunology, Division of Medicine, University of Thessaly, Panepistimiou 1, Larissa 41110, Greece. lsakkas@med.uth.gr
Telephone: +30-241-3502813
Received: August 4, 2018
Peer-review started: August 6, 2018
First decision: October 10, 2018
Revised: January 9, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: January 31, 2019
Abstract

Cardiovascular disease (CVD) has been associated with the so-called traditional risk factors, such as hypertension, hypercholesterolemia and cigarette smoking. Chronic inflammation, exemplified by elevated high sensitivity C-reactive protein, has been added to these risk factors for CVD as non-traditional risk factor. There are two aspects in this association. The first is whether inflammation plays a pathogenic role in traditional risk factors-mediated CVD or it is just an epiphenomenon. The second is whether chronic inflammation caused by an inflammatory disease has any impact on CVD. Accumulated data have shown that inflammation has a central and inciting role in the development of atherosclerosis leading to increased CVD risk. How inflammation contributes to CVD is a topic of continuous research where mechanisms involving both innate and adaptive immune pathways are involved. Endothelial dysfunction, oxidative stress in vascular endothelial cells, macrophage accumulation, formation of inflammasome, production of tumor necrosis factor (TNF)-a, IL-1 and IL-6 characterize the inflammatory process leading to atherogenesis. Recently clonal hematopoiesis of indeterminate potential represents a surprising and novel mechanism underlying atherogenesis. Data from chronic rheumatic inflammatory diseases exemplify the complexity of mechanisms leading to increased CVD, while they also provide evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL6 agents, could control atherogenesis and ameliorate CVD risk. Recent groundbreaking work using biologic anti-IL-1b therapy to treat men and women who have had a prior heart attack provides the best proof of the pathogenic contribution of inflammation in the development of CVD.

Keywords: Cardiovascular disease, Coronary artery disease, Atherosclerosis, Inflammation, Innate immunity, Adaptive immunity, Biologic drugs

Core tip: The association of inflammation with cardiovascular disease (CVD) has two aspects. The first is whether inflammation plays a pathogenic role in traditional risk factors-mediated CVD or it is just an epiphenomenon. The second is whether chronic inflammation caused by an inflammatory disease has any impact on CVD. Chronic inflammation exemplified by elevated high sensitivity C-reactive protein has been added for risk factors for CVD. How inflammation contributes to CVD is a topic of continuous research. A trial showing that anti-IL1b monoclonal-antibody reduced cardiovascular events is the best proof of the pathogenic contribution of inflammation in atherosclerosis and CVD.