Background: In the last decade, the development of anti-inflammatory strategies
emerged as new trend in cardiovascular (CV) pharmacotherapy. Anti-inflammatory properties
have been previously identified in different classes of drugs used in primary CV prevention.
However, the extent to which the modification of inflammatory profile contributes in
determining CV outcome remains controversial.
Methods: Focusing on potential beneficial effects in primary prevention, this narrative review
provides a comprehensive and critical analysis of randomized clinical trials testing
anti-inflammatory treatments in CV disease.
Results: As upstream regulator of the hepatic production of C-reactive protein, tumor necrosis
factor-α, interleukin (IL)-6 and IL-1 pathways early emerged as potential targets for CV
prevention. More recently, additional strategies targeting lipoprotein-associated phospholipase
A2, pro-protein convertase subtilisin/kexin type 9, and intracellular pathways (such as p38 MAPK and different
isoforms of NADPH oxidase) have been tested.
Conclusion: Conflicting results emerged from clinical trials, emphasized the need to characterize the inflammatory
profile of the patients, to minimize the heterogeneity of study populations and to clarify the true value of
CRP as specific biomarker of atherosclerosis-related inflammation.