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Interplay between h...
Interplay between hypercholesterolaemia and inflammation in atherosclerosis: Translating experimental targets into clinical practice
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Tunon, J (author)
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- Back, M (author)
- Karolinska Institutet
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Badimon, L (author)
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Bochaton-Piallat, ML (author)
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Cariou, B (author)
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Daemen, MJ (author)
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Egido, J (author)
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Evans, PC (author)
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Francis, SE (author)
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- Ketelhuth, DFJ (author)
- Karolinska Institutet
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Lutgens, E (author)
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Matter, CM (author)
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Monaco, C (author)
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Steffens, S (author)
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Stroes, E (author)
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Vindis, C (author)
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Weber, C (author)
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Hoefer, IE (author)
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(creator_code:org_t)
- 2018-05-14
- 2018
- English.
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In: European journal of preventive cardiology. - : Oxford University Press (OUP). - 2047-4881 .- 2047-4873. ; 25:9, s. 948-955
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https://academic.oup...
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http://kipublication...
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https://doi.org/10.1...
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Abstract
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- Dyslipidaemia and inflammation are closely interconnected in their contribution to atherosclerosis. In fact, low-density lipoprotein (LDL)-lowering drugs have anti-inflammatory effects. The Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS) has shown that interleukin (IL)-1β blockade reduces the incidence of cardiovascular events in patients with previous myocardial infarction and C-reactive protein levels >2 mg/L. These data confirm the connection between lipids and inflammation, as lipids activate the Nod-like receptor protein 3 inflammasome that leads to IL-1β activation. LDL-lowering drugs are the foundation of cardiovascular prevention. Now, the CANTOS trial demonstrates that combining them with IL-1β blockade further decreases the incidence of cardiovascular events. However, both therapies are not at the same level, given the large evidence showing that LDL-lowering drugs reduce cardiovascular risk as opposed to only one randomized trial of IL-1β blockade. In addition, IL-1β blockade has only been studied in patients with C-reactive protein >2 mg/L, while the benefit of LDL-lowering is not restricted to these patients. Also, lipid-lowering drugs are not harmful even at very low ranges of LDL, while anti-inflammatory therapies may confer a higher risk of developing fatal infections and sepsis. In the future, more clinical trials are needed to explore whether targeting other inflammatory molecules, both related and unrelated to the IL-1β pathway, reduces the cardiovascular risk. In this regard, the ongoing trials with methotrexate and colchicine may clarify whether the cardiovascular benefit of IL-1β blockade extends to other anti-inflammatory mechanisms. A positive result would represent a major change in the future treatment of atherosclerosis.
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- ref (subject category)
- art (subject category)
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- By the author/editor
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Tunon, J
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Back, M
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Badimon, L
-
Bochaton-Piallat ...
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Cariou, B
-
Daemen, MJ
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show more...
-
Egido, J
-
Evans, PC
-
Francis, SE
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Ketelhuth, DFJ
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Lutgens, E
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Matter, CM
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Monaco, C
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Steffens, S
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Stroes, E
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Vindis, C
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Weber, C
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Hoefer, IE
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show less...
- Articles in the publication
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European journal ...
- By the university
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Karolinska Institutet