Peter Libby, John Deanfield and Charalambos Antoniades talk about the relevance of coronary inflammation in clinical practice and discuss how inflammation in the coronary circulation can be measured.

Charalambos Antoniades explains why coronary inflammation needs to be diagnosed and treated and shows how perivascular fat analysis from routine CTCA can provide a quantitative assessment of coronary inflammation.

Prof. Peter Libby brings us up to date on some novel aspects of inflammation in atherosclerosis.

ESC 2021 The Nature-PCSK9 trial, a naturally randomized target trial, showed a stepwise increase in the proportional reduction in lifetime risk of CV events with each earlier decade that LDL-c lowering was started by inhibiting PCSK9 with one-yearly dose of siRNA.

Higher ratio of LDL-c/ApoB was associated with MACE and with all-cause mortality and total CV events in patients with established atherosclerosis in a prospective cohort study.

This study using data of PESA demonstrated that HbA1c levels are associated with risk for subclinical atherosclerosis in low-risk individuals without diabetes, even at levels below the prediabetes threshold.

This prospective registry study in the US showed that only 17.1% of patients with ASCVD on LLT had their therapy intensified over the next 2 years. Only 31.7% of patients achieved LDL-c levels <70mg/dL at 2 years.

ACC 2021 This subanalysis of the EVAPORATE trial showed a significant reduction in whole-heart atherosclerotic plaque burden over 18 months in statin-treated patients with elevated triglyceride levels who received icosapent ethyl compared to those on placebo.

This analysis in a community-based cohort showed that elevated carotid intima-media thickness and interadventitial diameter and lower carotid distensibility were associated with increased risk of incident dementia.

This pooled patient-level analysis of three phase 3 trials (ORION-9, -10 and -11) shows that inclisiran reduces LDL-c on average by 50.7% compared to placebo in patients on maximally tolerated statin-therapy.

The prospective BIOSIGNAL cohort study showed that elevated Lp(a) was independently associated with LAA stroke etiology and risk of recurrent AIS or TIA in patients <60 years.

In a contemporary primary prevention cohort, MI and ASCVD event rates increased with higher LDL-c and older age. NNT to prevent one MI or ASCVD event was lower in people aged 70-100 years compared to younger individuals.