Author + information
- Received May 10, 2018
- Revision received June 22, 2018
- Accepted June 25, 2018
- Published online December 17, 2018.
- ↵∗Address for correspondence:
Dr. Paul M Ridker, Director, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Avenue, Boston, Massachusetts 02215.
Life-threatening cardiovascular events occur despite control of conventional risk factors. Inflammation, as measured by high-sensitivity C-reactive protein (hsCRP) concentration, is associated with future vascular events in both primary and secondary prevention, independent of usual risk markers. Statins are powerful lipid-lowering agents with clinically relevant anti-inflammatory effects. Recent data support targeting the interleukin (IL)-1-to-IL-6-to-CRP signaling pathway as an adjunctive method for atheroprotection. The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial showed that reducing inflammation through IL-1β inhibition significantly reduced vascular risk, beyond that achievable with lipid lowering. CANTOS further demonstrated a 31% reduction in cardiovascular mortality and all-cause mortality among patients treated with canakinumab who achieved the largest reductions in hsCRP, as well as efficacy in high-risk patients with chronic kidney disease and diabetes. This review outlines the clinical implications of CANTOS for patients with “residual inflammatory risk,” the potential benefits and risks associated with anti-inflammatory therapy, and the importance of CANTOS for future drug development.
Dr. Ridker has received research support for CANTOS from Novartis; has consulted for Novartis, Pfizer, Inflazome, and Corvidia; and holds patents assigned to Brigham and Women’s Hospital, licensed to AstraZeneca and Siemens.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received May 10, 2018.
- Revision received June 22, 2018.
- Accepted June 25, 2018.
- 2018 American College of Cardiology Foundation
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