ACC calls for more screening in new scientific statement on inflammation
The American College of Cardiology (ACC) has released a new scientific statement focused on the close link between inflammation and cardiovascular disease (CVD).
The statement, "Inflammation and Cardiovascular Disease Consensus," covers years of research, confirming that inflammation is an important underlying contributor to several CVDs, including coronary artery disease and heart failure.[1]
In recent years, interest in testing and treating inflammation has increased rapidly. The primary focus has been on how inflammation leads to an increased residual risk of coronary disease, even if a patient is on optimal medical therapy. This interest has been spurred my new research and the 2023 U.S. Food and Drug Administration (FDA) approval of colchicine, the first on-label drug approved to treat coronary inflammation.
"In aggregate, the evidence linking inflammation with atherosclerotic CVD is no longer exploratory, but is compelling and clinically actionable. The time for taking action has now arrived," the authors of the consensus statement wrote.
The new ACC consensus document covers inflammation screening, evaluations and how it all feeds into CVD risk assessments. Topics include inflammatory biomarkers in cardiovascular imaging, inflammation inhibition with behavioral and lifestyle risks and anti-inflammatory approaches in primary and secondary prevention. There is a heavy emphasis on the routine use of high-sensitivity C-reactive protein blood testing to identify additional patient risk. The report also provides an updated understanding of the role of chronic, low-grade inflammation in CVD and highlights new seminal research findings, especially in atherosclerosis, myocardial infarction, heart failure and pericarditis
The report also addresses current challenges and future opportunities. It cautions that not all trials of anti-inflammatory therapy in secondary prevention have been successful, and more trial evidence is needed before broad recommendations for other agents can be made. Additionally, the authors said in successful trials, the interplay between inflammation and key physiological systems often remains incompletely examined.
The consensus notes a promising area of research is the role that novel special pro-resolving bioactive lipid molecules play in promoting the resolution of inflammation and CVD risk reduction.
Key points from the ACC inflammation consensus
A key point in in the document is that inexpensive and widely available high-sensitivity C-reactive protein (hsCRP) blood testing should be use in all patients for evaluation of CVD risk in primary and secondary prevention. While there has been debate within the medical community regarding the utility of hsCRP, this statement details the data confirming its value in clinical decision making.
In patients with known CVD, hsCRP level is at least as predictive of future events as LDL cholesterol levels, even in patients treated with statin therapy.
Another key point from the document is the important role lifestyle interventions can play when it comes to reducing systemic inflammation. Examples include regular exercise (at least 150 minutes/week), use of the Mediterranean or DASH diet and the intake of omega-3 fatty acids, including two to three meals per week of fatty fish high in EPA and DHA. This advice also aligns with lifestyle management recommendations in the 2025 ACC/AHA High Blood Pressure Guideline.
Therapy to treat coronary inflammation
The consensus also outlines recommendations for anti-inflammatory approaches in secondary prevention. For example, among individuals taking statin therapy, consideration should be given to increase dosage into the higher intensity range if hsCRP levels remain >2 mg/L, irrespective of LDL cholesterol.
Low-dose colchicine reduces cardiovascular events among individuals with chronic, stable atherosclerosis. It is intended to be used as an adjunct to lipid lowering. At the same time, colchicine has not proven effective when initiated at the time of acute ischemia and should be avoided among individuals with significant liver or renal disease, according to the document.
Several novel anti-inflammatory agents, including IL-6 inhibitors, are now being evaluated in ongoing randomized trials in the settings of chronic kidney disease, dialysis, HFpEF, and acute coronary syndrome, the authors added.
To create this consensus, the ACC constituted a writing committee to review of seminal publications and looked at the outstanding questions on the role of inflammation. The committee’s work was supported only by the ACC without any commercial input.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]