Anti-inflammatory strategies for patients with atherosclerotic coronary disease.

Introduction: Atherosclerosis, the primary cause of coronary artery disease (CAD), progresses through subclinical, chronic, and acute phases, culminating in acute myocardial infarction (AMI). Historically viewed as a lipid-driven disorder, it is now recognized as an inflammatory disease. Despite achieving optimal low-density lipoprotein cholesterol reduction, many patients experience residual cardiovascular risk, largely attributed to persistent inflammation.

Areas covered: A comprehensive literature search has been performed on PubMed, Web of Science and Cochrane, up to July 2025, with no significant restrictions. The review explores the role of inflammation in plaque progression and destabilization, discusses emerging biomarkers for risk stratification, and summarizes current and investigational anti-inflammatory therapies. Special attention is given to the evolving understanding of acute versus chronic post-AMI inflammation and how this distinction may guide therapeutic strategies.

Expert opinion: Anti-inflammatory therapy has reshaped the landscape of cardiovascular prevention, yet challenges remain in patient selection, timing, and target identification. Novel imaging techniques and artificial intelligence-driven risk models offer promising avenues for personalized therapy. Future efforts should focus on precision-based approaches that target detrimental immune activation while preserving reparative processes, ensuring maximal clinical benefit.