Residual Inflammatory Risk ASCVD CKD

CE / CME

Expert Insights on Targeting Residual Inflammatory Risk in ASCVD and CKD

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: July 22, 2024

Expiration: July 21, 2025

Erin Michos
Erin Michos, MD, MHS, FACC, FAHA, FASE, FASPC

Activity

Progress
1 2 3
Course Completed

References

  1. Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2023. cdc.gov/kidney-disease/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.html. Accessed July 15, 2024.
  2. Zoccali C, Mallamaci F, Adamczak M, et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res. 2023;119:2017-2032.
  3. Feng XS, Farej R, Dean BB, et al. CKD prevalence among patients with and without type 2 diabetes: Regional differences in the United States. Kidney Med. 2022;4:100385.
  4. Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24:302-308.
  5. Ndumele CE RJ, Chow SL, et al. Cardiovascular-kidney-metabolic health: A presidential advisory from the American Heart Association. ahajournals.org/doi/10.1161/CIR.0000000000001184. Accessed July 15, 2024.
  6. Fox CS, Matsushita K, Woodward M, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380:1662-1673.
  7. Kidney Disease: Improving Global Outcomes CKDWG. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105:S117-S314.
  8. de Boer IH, Khunti K, Sadusky T, et al. Diabetes management in chronic kidney disease: A consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45:3075-3090.
  9. Naaman SC, Bakris GL. Diabetic nephropathy: Update on pillars of therapy slowing progression. Diabetes Care. 2023;46:1574-1586.
  10. Agarwal R, Fouque D. The foundation and the four pillars of treatment for cardiorenal protection in people with chronic kidney disease and type 2 diabetes. Nephrol Dial Transplant. 2023;38:253-257.
  11. Chertow GM, Correa-Rotter R, Vart P, et al. Effects of dapagliflozin in chronic kidney disease, with and without other cardiovascular medications: DAPA-CKD trial. J Am Heart Assoc. 2023;12:e028739.
  12. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227-3337.
  13. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.
  14. Long-Term Intervention with Pravastatin in Ischaemic Disease Study G. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-1357.
  15. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001-1009.
  16. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.
  17. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301-1307.
  18. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615-1622.
  19. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195-2207.
  20. Hoogeveen RC, Ballantyne CM. Residual cardiovascular risk at low LDL: Remnants, lipoprotein(a), and inflammation. Clin Chem. 2021;67:143-153.
  21. Gaba P, O'Donoghue ML, Park JG, et al. Association between achieved low-density lipoprotein cholesterol levels and long-term cardiovascular and safety outcomes: An analysis of FOURIER-OLE. Circulation. 2023;147:1192-1203.
  22. Lawler PR, Bhatt DL, Godoy LC, et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J. 2021;42:113-131.
  23. Alfaddagh A, Martin SS, Leucker TM, et al. Inflammation and cardiovascular disease: From mechanisms to therapeutics. Am J Prev Cardiol. 2020;4:100130.
  24. Alicic RZ, Johnson EJ, Tuttle KR. Inflammatory mechanisms as new biomarkers and therapeutic targets for diabetic kidney disease. Adv Chronic Kidney Dis. 2018;25:181-191.
  25. Libby P. Inflammation in atherosclerosis-no longer a theory. Clin Chem. 2021;67:131-142.
  26. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836-843.
  27. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557-1565.
  28. Ridker PM, Danielson E, Fonseca FA, et al. Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet. 2009;373:1175-1182.
  29. Ridker PM. The time to initiate anti-inflammatory therapy for patients with chronic coronary atherosclerosis has arrived. Circulation. 2023;148:1071-1073.
  30. Ridker PM, Lei L, Louie MJ, et al. Inflammation and cholesterol as predictors of cardiovascular events among 13 970 contemporary high-risk patients with statin intolerance. Circulation. 2024;149:28-35.
  31. Amdur RL, Feldman HI, Dominic EA, et al. Use of measures of inflammation and kidney function for prediction of atherosclerotic vascular disease events and death in patients with CKD: Findings from the CRIC study. Am J Kidney Dis. 2019;73:344-353.
  32. Deanfield J, Buse JB, Gerward S, et al. Proportion of patients with systemic inflammation and their characteristics for groups at high cardiovascular risk in phase 3 randomized placebo-controlled trials of semaglutide (SELECT, SOUL, FLOW). Eur Heart J. 2023;44:ehad655.2752.
  33. Bendotti G, Montefusco L, Lunati ME, et al. The anti-inflammatory and immunological properties of GLP-1 Receptor Agonists. Pharmacol Res. 2022;182:106320.
  34. Askarpour M, Khani D, Sheikhi A, Ghaedi E, Alizadeh S. Effect of bariatric surgery on serum inflammatory factors of obese patients: A systematic review and meta-analysis. Obes Surg. 2019;29:2631-2647.
  35. Verma S, Bhatta M, Davies M, et al. Effects of once-weekly semaglutide 2.4 mg on C-reactive protein in adults with overweight or obesity (STEP 1, 2, and 3): Exploratory analyses of three randomised, double-blind, placebo-controlled, phase 3 trials. EClinicalMedicine. 2023;55:101737.
  36. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221-2232.
  37. Colhoun HM, Lingvay I, Brown PM, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nat Med. 2024.
  38. Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391:109-121.
  39. Colchicine [prescribing information]. Philadelphia, PA: AR Scientific, Inc; 2009.
  40. Bonaventura A, Abbate A. Colchicine for cardiovascular prevention: the dawn of a new era has finally come. Eur Heart J. 2023;44:3303-3304.
  41. LODOCO [prescribing information]. Parsippany, NJ: Agepha Pharma USA, Inc; 2023.
  42. Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol. 2013;61:404-410.
  43. Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in patients with chronic coronary disease. N Engl J Med. 2020;383:1838-1847.
  44. Nelson K, Fuster V, Ridker PM. Low-dose colchicine for secondary prevention of coronary artery disease: JACC review topic of the week. J Am Coll Cardiol. 2023;82:648-660.
  45. Tardif JC, Kouz S, Waters DD, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019;381:2497-2505.
  46. Tong DC, Quinn S, Nasis A, et al. Colchicine in patients with acute coronary syndrome: The Australian COPS randomized clinical trial. Circulation. 2020;142:1890-1900.
  47. Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148:e9-e119.
  48. Libby P. Targeting inflammatory pathways in cardiovascular disease: The inflammasome, interleukin-1, interleukin-6 and beyond. Cells. 2021;10.
  49. Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377:1119-1131.
  50. Aday AW, Ridker PM. Antiinflammatory therapy in clinical care: The CANTOS trial and beyond. Front Cardiovasc Med. 2018;5:62.
  51. Ridker PM, MacFadyen JG, Everett BM, et al. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial. Lancet. 2018;391:319-328.
  52. Ridker PM, Libby P, MacFadyen JG, et al. Modulation of the interleukin-6 signalling pathway and incidence rates of atherosclerotic events and all-cause mortality: analyses from the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS). Eur Heart J. 2018;39:3499-3507.
  53. Everett BM, MacFadyen JG, Thuren T, Libby P, Glynn RJ, Ridker PM. Inhibition of interleukin-1beta and reduction in atherothrombotic cardiovascular events in the CANTOS trial. J Am Coll Cardiol. 2020;76:1660-1670.
  54. Ridker PM, Tuttle KR, Perkovic V, Libby P, MacFadyen JG. Inflammation drives residual risk in chronic kidney disease: a CANTOS substudy. Eur Heart J. 2022;43:4832-4844.
  55. Ridker PM, Rane M. Interleukin-6 signaling and anti-interleukin-6 therapeutics in cardiovascular disease. Circ Res. 2021;128:1728-1746.
  56. Collaboration IRGCERF, Sarwar N, Butterworth AS, et al. Interleukin-6 receptor pathways in coronary heart disease: a collaborative meta-analysis of 82 studies. Lancet. 2012;379:1205-1213.
  57. Ridker PM, Devalaraja M, Baeres FMM, et al. IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet. 2021;397:2060-2069.