Maseri-Florio Keynote: The Role of Inflammation in CAD

When Alfred A. Bove, MD, PhD, MACC, began his research on patients who showed no evidence of coronary artery disease (CAD), but suffered from chest pain and ischemia, he followed a path mapped by Attilio Maseri, MD, FACC, that focused on coronary spasm. Fifty years later, as he presents a lecture named for Maseri, Bove is seeing much of their work eclipsed by a recent groundbreaking discovery about the role of inflammation in CAD.

“Fast-forward to 2017 and we have the CANTOS trial, which was a study of an anti-inflammatory monoclonal antibody,” Bove says about that discovery. “We reversed course and asked, ‘What is this inflammation stuff? Where did it come from?’ Most people did not connect it to coronary disease or spasm until recently.”

“Studies have begun to show some link between inflammation and spasm of the coronary arteries, and inflammation and coronary artery disease itself,” Bove adds.

Today’s Maseri-Florio International Keynote will trace the history of CAD evaluation from coronary spasm research through the findings about inflammation. The lecture will have a hint of irony because Bove and Maseri spent decades focused on using imaging to document the development of CAD.

Beyond looking at effects of inflammation in CAD, Bove, professor emeritus of medicine at Lewis Katz School of Medicine at Temple University, Philadelphia, also will examine how the entire cardiovascular community needs to deal with the challenge of using this new information in practice.

Cardiology Magazine Image"Now we’re in an era where we are beginning to understand that inflammation is an important part of everything we do in medicine." Alfred A. Bove, MD, PhD, MACC

“How do we bring this to the forefront of cardiology? It is not a procedure. It is an understanding of a process,” he says. “There is a real need for development of anti-inflammatory medications that fall back on basic research. We’re just at the beginning of understanding how inflammation affects the cardiovascular system.”

“I think we’re going to see some real advances because the idea of inflammation has passed muster in a big clinical trial and the people at the National Institutes of Health are now going to begin following up on developing this,” Bove says.

The recognition of the role of inflammation in CAD also means the cardiology education community must quickly adapt to teaching the new approach. During their fellowships, cardiologists learn about procedures, such as PCI as well as transcatheter aortic valve replacement, Bove says. The inflammatory process is not part of the curriculum.

“How do we teach this?” Bove asks “If inflammation is a major part of cardiovascular disease and we do not mention the word in three years of education in cardiology fellowships, we are going to have to go back and rethink the education process.”

Treatment will require medication to address the inflammatory process to block it before it causes a problem. Bove notes the entire medical community needs to recognize the potential of managing inflammation in treating a variety of diseases and conditions – and this makes this lecture an important starting point for learning.

“Now we’re in an era where we are beginning to understand that inflammation is an important part of everything we do in medicine,” Bove says. “It turns out the core of all the problems we have probably works its way back to the inflammatory process.”

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session

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