Role of inflammation and imunity in atherosclerosis and possible ways of their control.

Atherosclerosis and its clinical manifestations are characterised by ongoing arterial wall inflammation. Innate and adaptive imunity patterns are involved in all stages of atherosclerosis. Intensity of inflammation, more advanced proatherogenic imunity activity enhance development of cardiovascular (CV) disease. Efforts to control inflammation and imune proatherogenic patterns face considerable problems, but recent clinical studies offer promissing results. Statins have antiinflammatory effect, but PCSK9 monoclonal antibodies not. SGLT2 inhibitors (gliflozins) have a proven antiinflammatory effect and this might partly explain their protective CV effect. Recent clinical studies, COLCOT with colchicine and CANTOS with cinakinumab decreased inflammatory activity, CV mortality and incidence of defined CV endpoints. Other approaches to control inflammation in atherosclerosis are considered, namely blocation of proatherogenic cytokins by specific antibodies and intervention of metabolism of inflammatory cells. Vaccination against PCSK9 is being developed. Further studies may aim on active IL-1beta - IL-6 axis blocation nad on blocation of proatherogenic cytosins. Patients with signs of persistent inflammation, with specified inflammatory stage and with atherosclerotic leasion more precisely defined will be included.