Lipid Lowering Agents, Inflammation and Atherosclerosis

Atherosclerosis has been recognized as an inflammatory disease. The innate and adaptive immunity mechanisms are involved in atherogenesis. Low-grade inflammation is associated with innate immunity activation. The CRP has been proposed as the best indicator of low-grade inflammation and a predictor of cardiovascular events. A triumvirate of targets in the prevention of CVD are: LDL-C aggressive lowering, HDL-C increasing and CRP lowering. The statins' role in lipids and CRP lowering is well established. Moreover, statins may be beneficial in many other inflammatory immune conditions. Among PPAR-α agonists, anti-inflammatory properties of fenofibrate are the best demonstrated. PPAR-γ agonists (thiazolidinediones) pleiotropic effects are also promising. PPAR α/γ agonists have been proved to cause severe side effects. Ezetimibe exerts beneficial anti-inflammatory actions when administered with statins. Colesevelam, a novel bileacid sequestrant has beneficial lipid-lowering and anti-inflammatory actions. CETP and ACAT inhibitors actions call for further studies. Inhibition of CRP, CRP-targeted antisenses, HDL-particle modification and immunomodulation of atherosclerosis are possible novel approaches in atherosclerosis treatment and prevention.