Cumulative evidence links inflammation with atherothrombotic disease. Conversely, the role of modulating the inflammatory process as a therapeutic target has remain an unproven hypothesis until the execution of the CANTOS trial (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study). On the one hand, this trial provides robust evidence that interleukin-1β (IL-1β) inhibition by canakinumab reduces the incidence of repetitive atherothrombotic events in patients with postmyocardial infarction already on state-of-the-art treatment but with a residual inflammatory risk. On the other hand, the absolute antiatherothrombotic effect size of this intervention seems small (189 patients had to be intervened during 1 year to prevent 1 myocardial infarction episode) and associated with a mild increase in the incidence of serious adverse events (≈1 in 750 patients intervened during 1 year developed a fatal infection or sepsis). Beyond all these considerations, CANTOS represents a gigantic (10 000 patients) proof-of-concept trial.

Atherosclerosis is a systemic disease with a long clinically silent phase. Arterial wall lipid deposition, the hallmark of atherosclerosis, begins early in life. Atherosclerotic plaques grow gradually for several years, the disease becoming clinically overt only when the plaque is large enough to restrict blood flow or becomes unstable and ruptures, causing a thrombus. From its earliest asymptomatic phase through to the late clinical manifest stages, atherosclerosis is predominantly an inflammatory disease, featuring leukocyte activation, cytokine release, and infiltration by eosinophils, neutrophils, and macrophages. Epidemiological studies have revealed that circulating inflammatory biomarkers, especially C-reactive protein (CRP) measured by a high sensitivity (hs) assay, are associated with a higher incidence of atherothrombotic events (myocardial infarction, stroke, etc.).¹ All these observations suggested that strategies to reduce inflammation would lead to a reduction in atherothrombotic events. However, it is important to note that the evidence linking inflammation to atherosclerosis is associative, and evidence for a causal role of inflammation in atherothrombotic …

累积的证据表明炎症与动脉粥样硬化性血栓形成有关。相反，直到执行CANTOS试验（Canakinumab抗炎性血栓形成结果研究），调节炎症过程作为治疗目标的作用仍未得到证实。一方面，该试验提供了有力的证据，表明canakinumab对白介素-1β（IL-1β）的抑制作用已降低了已经采用最新技术治疗但仍具有炎性风险的心肌梗死后反复动脉粥样硬化性血栓形成事件的发生率。另一方面，这种干预措施的绝对抗动脉血栓形成作用的大小似乎很小（在1年内必须干预189例患者，以预防1例心肌梗塞发作），并且与严重不良事件的发生率轻度增加相关（在1年中干预的750例患者中≈1发生致命的感染或败血症）。除了所有这些考虑因素，CANTOS代表了一项巨大的（10,000例患者）概念验证试验。

动脉粥样硬化是一种具有长期临床沉默期的全身性疾病。动脉壁脂质沉积是动脉粥样硬化的标志，始于生命早期。动脉粥样硬化斑块逐渐生长数年，只有当斑块大到足以限制血液流动或变得不稳定和破裂并引起血栓时，该疾病才在临床上变得明显。从最早的无症状期到临床表现的晚期，动脉粥样硬化主要是一种炎症性疾病，其特征在于白细胞活化，细胞因子释放以及嗜酸性粒细胞，嗜中性粒细胞和巨噬细胞的浸润。流行病学研究表明，循环炎症生物标志物，尤其是通过高灵敏度（hs）测定法测量的C反应蛋白（CRP），¹所有这些观察结果表明，减少炎症的策略将导致血栓形成事件的减少。但是，必须注意的是，将炎症与动脉粥样硬化联系起来的证据是相关的，并且炎症在动脉粥样硬化性血栓形成中起因果作用的证据……