Systemic vascular inflammation plays multiple maladaptive roles which contribute to the progression and destabilization of atherosclerotic cardiovascular disease (ASCVD). These roles include: (i) driving atheroprogression in the clinically stable phase of disease; (ii) inciting atheroma destabilization and precipitating acute coronary syndromes (ACS); and (iii) responding to cardiomyocyte necrosis in myocardial infarction (MI). Despite an evolving understanding of these biologic processes, successful clinical translation into effective therapies has proven challenging. Realizing the promise of targeting inflammation in the prevention and treatment of ASCVD will likely require more individualized approaches, as the degree of inflammation differs among cardiovascular patients. A large body of evidence has accumulated supporting the use of high-sensitivity C-reactive protein (hsCRP) as a clinical measure of inflammation. Appreciating the mechanistic diversity of ACS triggers and the kinetics of hsCRP in MI may resolve purported inconsistencies from prior observational studies. Future clinical trial designs incorporating hsCRP may hold promise to enable individualized approaches. The aim of this Clinical Review is to summarize the current understanding of how inflammation contributes to ASCVD progression, destabilization, and adverse clinical outcomes. We offer forward-looking perspective on what next steps may enable successful clinical translation into effective therapeutic approaches-enabling targeting the right patients with the right therapy at the right time-on the road to more individualized ASCVD care.

中文翻译：

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针对心血管炎症：临床转化的下一步

全身性血管炎症发挥多种不适应作用，导致动脉粥样硬化性心血管疾病 (ASCVD) 的进展和不稳定。这些作用包括：（i）在疾病的临床稳定期推动动脉粥样硬化进展；(ii) 引起动脉粥样硬化不稳定和诱发急性冠状动脉综合征 (ACS)；(iii) 应对心肌梗塞 (MI) 中的心肌细胞坏死。尽管对这些生物过程的理解不断发展，但成功将临床转化为有效疗法已被证明具有挑战性。由于心血管患者的炎症程度不同，因此在预防和治疗 ASCVD 中实现靶向炎症的承诺可能需要更多的个体化方法。大量证据支持使用高敏 C 反应蛋白 (hsCRP) 作为炎症的临床测量方法。了解 ACS 触发器的机制多样性和 MI 中 hsCRP 的动力学可能会解决先前观察研究中据称的不一致之处。未来纳入 hsCRP 的临床试验设计可能有望实现个性化方法。本临床综述的目的是总结目前对炎症如何促进 ASCVD 进展、不稳定和不良临床结果的理解。我们就下一步可能使临床成功转化为有效的治疗方法——在正确的时间以正确的治疗针对正确的患者——在通往更加个性化的 ASCVD 护理的道路上提供前瞻性的观点。