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Dawn of a new era for atherosclerosis

It has been recognised for decades that the hardening of arteries (or atherosclerosis), the cause of heart attacks and strokes, has the hallmarks of an inflammatory response.

Atherosclerosis, have many of the chief ‘dramatis personae’ of a severe inflammatory response, including infiltration by inflammatory cells and ongoing destruction of tissue.

Moreover individuals who have high levels of inflammatory markers in the serum (measured by CRP) have a higher risk of having heart attacks or strokes.

The logical therapeutic approach therefore is to treat atherosclerosis like we treat other inflammatory conditions, like rheumatoid arthritis.

However, and this has been a huge puzzle in the area of cardiovascular medicine, in-spite of decades of trying to show that this is an effective way of preventing disease the trials have failed.

Until last week, the results of CANTOS trial appeared in the New England Journal of MedicineAntiinflammatory Therapy with Canakinumab for Atherosclerotic Disease, that show that one injection every three months of a drug, Canakinumab, that inhibits a chief component of the inflammatory response (interleukin-1) prevents heart attacks and strokes.

This is a major breakthrough that will provide a new armamentarium for physicians treating high risk patients (ie. with high levels of CRP), and certainly lead to a host of new trials to fine tune the way the drug, and its derivatives will be used.

But more than that, this discovery firmly puts inflammation at the center of the causation of cardiovascular disease in adults, and reaffirms the need to keep in check other sites of inflammation (such as seen in periodontitis) that are also associated with increased cardiovascular risk.

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Metaflammation

Inflammation is all good. It is an essential repair process that heals the body, defends it from infection.

However it is also a very powerful process, which when left unchecked causes many diseases directly (like arthritis) but also indirectly (like cancer and vascular disaeses).

A new aspect of inflammation is coming to light, its connection with chronic metabolic diseases, like obesity and diabetes.

In fact its has been given a new name ‘Metaflammation’. 

http://www.nature.com/nature/journal/v542/n7640/full/nature21363.html

One of the reasons this link is really important is that we are able to control with small molecule or biological therapeuti s some aspects of inflammation and thus this approach might become really useful in treating some diseases that were thought to be diet or environment influenced..and are looking to become a devastating problem in the future.