Inflammation plays an important role in both the initiation and progression of atherosclerosis.

The human arterial endothelium is complex organ that functions to prevent blood clot formation, producing anti-coagulant and anti-inflammatory molecules. When LDL cholesterol enters the internal elastic lamina and becomes oxidized, it sets in motion an inflammatory cascade leading to an accumulation of lipid-rich foam cells and development of an atherosclerotic plaque. Dr. Scirica describes this process in detail as well as the role of the innate immunity in the development of atherosclerosis.

Atherosclerosis is a progressive disease moving from stage to stage over decades, and this may happen in “fits and spurts,” with active and quiescent phases. Elevated LDL cholesterol levels are a key risk factor for future cardiovascular events and so is chronic low-grade systemic inflammation, as indicated by high-sensitivity C-reactive protein (hsCRP) levels.

Cholesterol lowering statin treatment has been widely used in patients with elevated cholesterol for reducing their cardiovascular risk, however, lately, results from the JUPITER trial also showed that statin treatment reduced cardiovascular risk in individuals having “low” LDL cholesterol levels (<130 mg/dL) and elevated hsCRP. A statistically significant reduction in all-cause mortality was also seen. Further studies on the effects of direct anti-inflammatory interventions on cardiovascular risk remain to be seen.

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After viewing this presentation the participant will be able to:

- List the molecular processes in the development of an atherosclerotic plaque
- Describe the biology of atherothrombosis
- Relate inflammation levels to cardiovascular risk
- Discuss recent findings on primary prevention of cardiovascular events in individuals with elevated hsCRP levels

Braunwald's Heart Disease 8th Ed

Göran K. Hansson, M.D., Ph.D.
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Paul M Ridker, M.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., Børge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., Robert J. Glynn, Sc.D., for the JUPITER Study Group Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein NEJM 2008;359:2195-2207.