Systemic Review of Inflammatory Pathways and Immune Modulation in Atherosclerotic Cardiovascular Disease.

Abstract

Inflammation is a central contributor to atherosclerotic cardiovascular disease (ASCVD), and targeted immune modulation may provide added benefit beyond lipid-lowering. We conducted a systematic review (PRISMA 2020-compliant) of 57 studies published between 2000 and 2025, including randomized trials, observational cohorts, biomarker analyses and genetic studies, to evaluate inflammatory pathways and immunomodulatory therapies in ASCVD. Interleukin-1 beta (IL-1β) inhibitors and colchicine consistently reduced major cardiovascular events without affecting lipid levels, with colchicine showing benefit even at low CRP. interleukin-6 (IL-6) inhibitors demonstrated strong biomarker suppression, though outcome trials are still in progress. Methotrexate showed no clinical benefit, and biologics carried a modest infection risk. Risk of bias was low across most included studies. In conclusion, anti-inflammatory therapy appears to be a promising adjunct in ASCVD prevention, especially for patients with residual inflammatory risk. Colchicine has the most consistent supporting evidence, and further trials are warranted to clarify the role of IL-6 inhibition and personalized treatment strategies.