Taming inflammation in coronary artery disease: lessons learned, translational breakthroughs, and future directions

Inflammation is an essential physiological process that preserves host homeostasis, yet chronic inflammation is now recognized as a common pathological basis of many chronic diseases. In coronary artery disease (CAD), chronic inflammation is central to the initiation and progression of atherosclerosis. Accordingly, anti-inflammatory therapy has emerged as a major focus of investigation in this field. Although multiple inflammatory pathways have been evaluated as therapeutic targets in clinical trials, strategies with demonstrated clinical benefit remain limited. In this review, we examine the sources of inflammation in CAD, approaches to inflammatory risk stratification, and advances in anti-inflammatory therapy. To explain divergent trial outcomes and guide future clinical translation, we propose a 4R framework: the right target, the right patient, the right timing, and the right benefit–risk balance. Anti-inflammatory treatment remains promising. Within this framework, refined inflammatory phenotyping and evaluation of stage-dependent efficacy represent immediate priorities for future trials.