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Panarteritis: beyond the vulnerable plaque

ESC Congress 2010

Acute Coronary Syndromes (ACS)


Low grade diffuse inflammation is responsible for initiation and continuation of atherosclerosis also at the peripheral level, said Prof L. Biasucci, from the Catholic School of Medicine in Rome, during his presentation at the beginning of the session. Obesity and metabolic syndrome and perhaps chronic low-grade infections, may represent the keys of the phenomenon. Their prevention and treatment might reduce the burden of peripheral artery disease. However, some controversial aspects on mechanisms and triggers of subclinical inflammation peripherally deserve more in depth studies.

Prof N. Sattar from Glasgow addressed the problem of inflammation in autoimmune and connective tissue disorders. He underlined that, in these patients, inflammation works as an independent factor that interacts with traditional CV risk factors which are generally undertreated in these subjects. He also discussed the evidence that controlling for marked increased inflammatory status can have a beneficial effect on the high CV risk of these patients but concluded that definitive data, in this regard, are still lacking.

Prof G. Schillaci, a well known expert in hypertension from the University of Perugia, declared that traditional risk factors are enhanced also in HIV-infected persons. Thus, a rationale exists for active identification and aggressive intervention similar to the general population. He also recognized that retroviral treatment is associated with an increased risk of CV disease but definitely its benefits outweigh its potential damage.

Prof J Lekakis from Athens concluded the session with an overview of the supposed benefit of systemic anti-inflammatory treatment. His conclusion was that, given the strong conviction that inflammation is at the base of atherosclerosis, diet, use of statins, ACE- inhibitors and aspirin remain the cornerstone for such a treatment. The benefit, however, deriving from targeting potent pro-inflammatory mediators is still missing, at least until clinical studies under way come to a conclusion.

References


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Panarteritis: beyond the vulnerable plaque
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.