Rolle der Inflammation in der Atherosklerose – Ein Update

Die Atherosklerose zeigt typische Charakteristika eines inflammatorischen Prozesses, sowohl lokal in der Gefäßwand als auch systemisch. Verschiedene klinische Krankheitsbilder, die mit einer systemischen Inflammation einhergehen, sind gehäuft mit atherosklerotischen Komplikationen assoziiert. In prospektiven Studien konnte ein Zusammenhang zwischen erhöhten Plasma-/Serumkonzentrationen sensitiver Marker, einer systemischen Inflammation und dem Auftreten kardiovaskulärer Ereignisse gezeigt werden. Hier ist insbesondere das C-reaktive Protein zu nennen, welches kürzlich zur verbesserten Risikostratifizierung Eingang in die kanadischen Leitlinien zur kardiovaskulären Prävention gefunden hat. Nach indirekten positiven Hinweisen aus der JUPITER-Studie wird die Inflammationshypothese derzeit mit spezifischeren antiinflammatorischen Substanzen in großen randomisierten klinischen Studien getestet, um das immer noch hohe residuale Risiko kardiovaskulärer Ereignisse bei Patienten mit Atherosklerosemanifestationen trotz optimaler Polypharmakotherapie weiter zu senken.

Atherosclerosis shows typical features of a local and systemic inflammatory process. Thus, many diseases with underlying chronic systemic inflammation are associated with atherosclerotic complications, in particular coronary heart disease. Prospective observational studies identified various sensitive biomarkers of inflammation as predictors of cardiovascular risk, in apparently healthy individuals as well as in patients with manifest atherosclerosis. Among them, C-reactive protein, measured by high-sensitivity assays, has received widespread attention and was recently included in the Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease. After indirect positive evidence from the JUPITER study, the inflammatory hypothesis is presently being tested in large randomized clinical trials with new, more specific anti-inflammatory compounds, with the intention to translate advances in basic science into clinical practice.

Key words

Inflammation - atherosclerosis - innate and adaptive immunity - coronary heart disease

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