Imaging and targeting coronary artery inflammation.
West HW., Antoniades C.
Significance Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality across the world despite significant progress in prevention, diagnosis and treatment of atherosclerotic disease. Recent Advances The focus of the cardiovascular community has shifted towards seeking a better understanding of the inflammatory mechanisms driving residual CAD risk not modulated by current therapies. Significant progress has been achieved in revealing both pro-inflammatory and anti-inflammatory mechanisms, and how shift of the balance in favour of the former, can drive the development of disease. Critical Issues Advances in the non-invasive detection of coronary artery inflammation have been forthcoming. These advances include multiple imaging modalities, with novel applications of computed tomography both with and without positron emission tomography, and experimental ultrasound techniques. These advances will enable better selection of patients for anti-inflammatory treatments and assessment of response. The rapid advancement in pharmaceutical design has enabled the production of specific antibodies against inflammatory pathways of atherosclerosis, with modest success to date. The pursuit of demonstrating efficacy and safety of novel anti-inflammatory and/or pro-inflammation resolution therapies for atherosclerotic CAD has become a major focus. Future Directions This review seeks to provide an update of the latest evidence of all three of these highly related but disparate areas of inquiry: Our current understanding of the key mechanisms by which inflammation contributes to coronary artery atherosclerosis, the evidence for non-invasive assessment of coronary artery inflammation, and finally, the evidence for targeted therapies to treat coronary inflammation for the reduction of CAD risk.