Inflammatory Residual Risk — EECC MCQ

Correct answer: C — High-sensitivity C-reactive protein (hs-CRP) identifies patients with inflammatory residual risk — the CANTOS trial showed anti-IL-1β therapy (canakinumab) reduced MACE in patients with elevated hs-CRP despite statin therapy, establishing inflammation as a therapeutic target

The correct answer is C. In patients with established atherosclerotic disease such as prior MI, recurrent cardiovascular events may occur despite appropriate LDL-C lowering; this is termed residual risk. One component is inflammatory residual risk, most commonly assessed in research and specialist cardiovascular literature using high-sensitivity C-reactive protein (hs-CRP), a marker of low-grade vascular inflammation. The CANTOS trial enrolled stable post-MI patients with persistently elevated hs-CRP despite contemporary secondary prevention and showed that IL-1β inhibition with canakinumab reduced hs-CRP/IL-6 without lowering LDL-C and reduced major adverse cardiovascular events, supporting inflammation as an independent therapeutic target. This does not mean that hs-CRP replaces standard UK secondary prevention or lipid targets; NICE-based UK practice still prioritises intensive lipid lowering and comprehensive post-MI secondary prevention. D-dimer relates mainly to thrombosis/fibrinolysis, ESR is a nonspecific inflammatory marker and is not preferred for cardiovascular residual risk assessment, and LDL-C is not the only determinant of residual cardiovascular risk.

Reference: NHS Specialist Pharmacy Service Medicines Awareness. Anti-inflammatory Therapy with Canakinumab for Atherosclerotic Disease (CANTOS; summary of NEJM 2017 trial). https://www.medicinesresources.nhs.uk/en/Medicines-Awareness/Primary-Research/Randomised-controlled-trials/Antiinflammatory-Therapy-with-Canakinumab-for-Atherosclerotic-Disease/