German Anguiano Torres

🔥🫀 Inflammation is no longer a hypothesis—it’s a therapeutic target The 2025 ACC Scientific Statement on Inflammation and Cardiovascular Disease marks a turning point: inflammation is now recognized as a causal, measurable, and actionable driver of cardiovascular risk, not just a bystander . 🧠 Key paradigm shift Even in statin-treated patients with optimal LDL-C, residual inflammatory risk—best captured by high-sensitivity C-reactive protein (hsCRP)—strongly predicts recurrent events and cardiovascular death. In fact, post-statin hsCRP is often more prognostic than LDL-C itself. 📏 Measure what you want to treat The statement makes a bold recommendation: 👉 Near-universal hsCRP screening in both primary and secondary prevention. hsCRP <1 mg/L → low risk 1–3 mg/L → intermediate risk 3 mg/L → high inflammatory risk Persistently elevated hsCRP (>2 mg/L) identifies patients who remain vulnerable despite guideline-directed therapy. 💊 Anti-inflammatory therapies: what works (and what doesn’t) ❌ Broad immunosuppression failed (e.g. methotrexate in CIRT). ✅ Targeted inflammation inhibition works: Canakinumab (CANTOS) proved the inflammation hypothesis—reducing events without lowering LDL-C. Low-dose colchicine (0.5 mg/day) reduced recurrent CV events by ~25% and is now FDA-approved for secondary prevention. 🚧 New frontiers: IL-6 inhibition (ziltivekimab, clazakizumab) in CKD, HFpEF, ACS—results expected soon. 🧘‍♂️ Lifestyle is anti-inflammatory medicine Mediterranean/DASH diets 🥗, omega-3 intake 🐟, exercise 🏃‍♀️, weight control, and smoking cessation are explicitly framed as anti-inflammatory interventions, not just “healthy habits.” 🖼️ Imaging: promising, not ready Advanced imaging of vascular inflammation (e.g. perivascular fat attenuation index) is exciting—but not yet for routine clinical use. 🔮 Bottom line Atherosclerosis is an inflammatory disease with lipid involvement. The time has come to treat cholesterol and inflammation—with biomarkers, lifestyle, and targeted therapies—moving cardiovascular prevention into a new era 🚀