Inflammation, infection, and cardiovascular risk

The Article by Paul M Ridker and colleagues stated that "among patients receiving contemporary statins, inflammation assessed by high-sensitivity C-reactive protein was a stronger predictor for risk of future cardiovascular events and death than cholesterol assessed by low-density lipoprotein cholesterol".1Ridker PM Bhatt DL Pradhan AD et al.Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials.Lancet. 2023; 401: 1293-1301Summary Full Text Full Text PDF PubMed Scopus (75) Google Scholar Triglyceride-rich lipoproteins have been implicated in proinflammatory signalling pathways, impairment of insulin sensitivity, and up-regulation of factors promoting thrombosis.2Bartlett J Predazzi IM Williams SM et al.Is isolated low high-density lipoprotein cholesterol a cardiovascular disease risk factor? New insights from the Framingham Offspring study.Circ Cardiovasc Qual Outcomes. 2016; 9: 206-212Crossref PubMed Scopus (71) Google Scholar Dysglycaemia is associated with inflammation, and both uncontrolled diabetes and renal insufficiency are associated with high cardiovascular risk.3Donath MY Shoelson SE Type 2 diabetes as an inflammatory disease.Nat Rev Immunol. 2011; 11: 98-107Crossref PubMed Scopus (2626) Google Scholar, 4Gerstein HC Dysglycemia and cardiovascular risk in the general population.Circulation. 2009; 119: 773-775Crossref PubMed Scopus (22) Google Scholar, 5Parikh NI Hwang SJ Larson MG Meigs JB Levy D Fox CS Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control.Arch Intern Med. 2006; 166: 1884-1891Crossref PubMed Scopus (190) Google Scholar Hazard ratios were adjusted for other variables, but not for haemoglobin A1C and estimated glomerular filtration rate. Hence, it would be interesting to know how the tertile analysis for haemoglobin A1C and estimated glomerular filtration rate of these patients correlate with inflammation and cardiovascular outcomes. Despite receiving triglyceride-lowering therapies, the median triglyceride concentrations did not reach less than 150 mg/dL. Studying the correlation between triglyceride levels and inflammation is therefore important. All authors are employees of Ipca Laboratories. Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trialsAmong patients receiving contemporary statins, inflammation assessed by high-sensitivity CRP was a stronger predictor for risk of future cardiovascular events and death than cholesterol assessed by LDLC. These data have implications for the selection of adjunctive treatments beyond statin therapy and suggest that combined use of aggressive lipid-lowering and inflammation-inhibiting therapies might be needed to further reduce atherosclerotic risk. Full-Text PDF Inflammation, infection, and cardiovascular risk – Authors' replyWe wholeheartedly agree with Timo E Strandberg and colleagues that LDL cholesterol is the most important target for atherosclerosis prevention, and we fully endorse evolving guidelines worldwide that seek ever lower concentrations of on-treatment LDL targets. We respectfully disagree, however, that the addition of anti-inflammatory therapy to lipid-lowering treatment is too little, too late. The absolute and relative risk reductions observed in trials of IL-1b inhibition1 and of colchicine2,3 are at least as large in magnitude as risk reductions associated with adjunctive lipid-lowering agents among patients already taking a statin. Full-Text PDF