Inflammation compared to low-density lipoprotein cholesterol: two different causes of atherosclerotic cardiovascular disease

Benjamin N. Wadström, Kasper M. Pedersen, Anders B. Wulff, Børge G. Nordestgaard*

*Corresponding author for this work
4 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Inflammation is gaining attention as a target for prevention of atherosclerotic cardiovascular disease (ASCVD). The purpose of this review is to compare the evidence for inflammation with the evidence for low-density lipoprotein (LDL) cholesterol in ASCVD. RECENT FINDINGS: Evidence from human genetic studies and randomized controlled trials implicate the inflammatory pathway from the inflammasome through interleukin (IL)-1 to IL-6 as a cause of ASCVD. Higher levels of IL-6 may lead to proportionally increased risk of ASCVD, and randomized controlled trials of IL-6 inhibitors are underway. The causal evidence for LDL cholesterol in ASCVD is overwhelming and recent important findings instead revolve around development of improved LDL cholesterol lowering therapy through RNA and DNA based therapeutics. Even though some lipid-lowering therapies lower IL-6, the IL-6 inflammatory pathway and LDL cholesterol are two separate causes of ASCVD. SUMMARY: IL-6 mediated inflammation most likely causes ASCVD, in parallel with LDL cholesterol. However, fewer individuals in the general population are exposed to high IL-6 than high LDL cholesterol. For inflammation, future research should focus on improving efficacy and safety of anti-inflammatory therapy, and for LDL cholesterol, future research should focus on wider and more effective implementation of LDL cholesterol lowering therapy.

Original languageEnglish
JournalCurrent Opinion in Lipidology
Volume34
Issue number3
Pages (from-to)96-104
Number of pages9
ISSN0957-9672
DOIs
Publication statusPublished - 1 Jun 2023

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