Emerging evidence of trained immunity and inflammatory programming in atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide despite major advances in risk factor attenuation and lipid-lowering therapies. Inflammation is a central driver of atherosclerosis, contributing to disease initiation, progression, and excess cardiovascular risk. This article summarizes the pathophysiology of atherosclerosis with a focus on the inflammatory mechanisms underlying plaque development and instability, anti-inflammatory therapeutic strategies, and the emerging role of epigenetic and metabolic programming of innate immune cells in perpetuating unresolved inflammation.