Managing ASCVD: Where Patients and Clinicians Still Need Help

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality. It results when plaque accumulates within arterial walls, and it encompasses conditions such as acute coronary syndrome (ACS), angina, stroke, and peripheral artery disease.¹ Risk factors for ASCVD include diabetes, dyslipidemia, hypertension, metabolic syndrome, and obesity.² In addition, systemic inflammation plays a key role in the development of ASCVD.³

High-sensitivity C-reactive protein (hs-CRP), a biomarker of systemic inflammation, is associated with higher rates of cardiovascular disease and all-cause mortality.³ Despite guideline-informed and evidence-based interventions to manage ASCVD risk factors, such as low-density lipoprotein cholesterol (LDL-C), patients remain at risk of cardiovascular events.^4,5 This underscores the independent contribution of systemic inflammation to ASCVD progression, irrespective of LDL-C level.^6,7

The Journal of Cardiovascular Pharmacology published survey results that evaluated the experiences of patients and health care professionals (HCPs) with ASCVD management. The survey focused on assessing unmet patient needs, determining HCP perceptions of inflammation in ASCVD, and identifying the need for therapies targeting inflammatory pathways.⁷

The researchers administered a 50-question survey to 200 patients with ASCVD and 89 HCPs, including cardiologists (83%) and cardiology nurse practitioners and physician assistants (17%). Participating patients were not under the care of participating HCPs.⁷

Patients and HCPs reported chest pain/discomfort as the most frequent symptom at presentation. Other common symptoms included issues with walking, breathing, and/or coughing. Approximately 57% of patients were diagnosed with ASCVD after a major event, most often in the inpatient setting by a cardiologist. The most common comorbidities were dyslipidemia (60%), hypertension (56%), obesity (44%), and diabetes (38%). The survey found that HCPs included hs-CRP more often than other inflammatory biomarkers in diagnosis workup. However, only 6% consistently tested hs-CRP, compared with 31% and 23%, who did so sometimes and often, respectively.⁷

Patients reported that their treatment included statins (78%) and an antiplatelet (65%). Despite treatment, chest pain and difficulty walking persisted in 28% of patients, whereas breathing and/or coughing problems persisted in 26%, with variable impact on quality of life. Only 18% of patients felt their treatment was working “extremely well,” and up to 55% of HCPs were “mostly satisfied” with available ASCVD treatments.⁷

The survey assessed awareness of clinical trials evaluating anti-inflammatory treatments for ASCVD. Most HCPs were aware of trials involving colchicine (Colcrys; Takeda Pharmaceuticals) or canakinumab (Ilaris; Novartis), and fewer were aware of ziltivekimab (Novo Nordisk). Of note, ziltivekimab has been shown to reduce inflammation in patients with chronic kidney disease and elevated hs-CRP, thus decreasing cardiovascular events.⁸ Ongoing studies are further evaluating ziltivekimab.⁷ Responses showed that 68% of HCPs prescribed colchicine for ASCVD in patients with gout or inflammation, and 50% correctly believed colchicine targets ASCVD causes and prevents recurrent events.

Although the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline did not discuss hs-CRP, most HCPs recognized inflammation as a key driver of plaque formation and CV events.^7,9 However, available treatments do not adequately address inflammation. Overall, 67% of HCPs expressed some level of agreement that hs-CRP could serve as an ASCVD monitoring tool, highlighting a gap in addressing inflammation in ASCVD.⁷

Implications by Practice Area

Consultant pharmacists and nurse practitioners are well-positioned to address inflammation as a modifiable risk in ASCVD. As members of an interdisciplinary team, they can advocate for the use of hs-CRP for risk assessment and as a monitoring tool. They can educate the care team on clinical trials of anti-inflammatory therapies for ASCVD and promote their evidence-based use.

REFERENCES

1. Atherosclerotic cardiovascular disease (ASCVD). American Heart Association. Accessed May 11, 2026. https://www.heart.org/en/professional/quality-improvement/ascvd

2. Roshanravan N, Tutunchi H, Parvizi R, et al. Risk factors for atherosclerotic cardiovascular disease (ASCVD) in healthcare professionals of Azar Cohort Study: a cross-sectional study. Health Promot Perspect. 2024;14(2):161-167. doi:10.34172/hpp.42568

3. Quispe R, Michos ED, Martin SS, et al. High-sensitivity C-reactive protein discordance with atherogenic lipid measures and incidence of atherosclerotic cardiovascular disease in primary prevention: the ARIC study. J Am Heart Assoc. 2020;9(3):e013600. doi:10.1161/JAHA.119.013600

4. Virani SS, Smith SC, Stone NJ, Grundy SM. Secondary prevention for atherosclerotic cardiovascular disease: comparing recent US and European guidelines on dyslipidemia. Circ. 2020;141(14):1121-1123. doi:10.1161/CIRCULATIONAHA.119.044282

5. Wong ND, Zhao Y, Quek RGW, et al. Residual atherosclerotic cardiovascular disease risk in statin-treated adults: the multi-ethnic study of atherosclerosis. J Clin Lipidol. 2017;11(5):1223-1233. doi:10.1016/j.jacl.2017.06.015

6. hsCRP insights for healthcare professionals. American Heart Association. Accessed May 11, 2026. https://professional.heart.org/en/education/hscrp-insights-for-healthcare-professionals

7. Weber B, McCarty D, Robar C, et al. Patients’ and healthcare professionals’ perspectives in managing atherosclerotic cardiovascular disease: a survey of unmet needs and perceived benefits of treating systemic inflammation in cardiovascular diseases. J Cardiovasc Pharmacol. Published online February 25, 2026. doi:10.1097/FJC.0000000000001800

8. Ridker PM, Devalaraja M, Baeres FMM, et al; RESCUE Investigators. IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomized, placebo-controlled, phase 2 trial. Lancet. 2021;397(10289):2060-2069. doi:10.1016/S0140-6736(21)00520-1

9. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862. doi:10.1161/CIR.0000000000001309