Healthcare professional awareness and use of inflammation-based risk assessment in ASCVD: The CARDIO-INFLAME survey

Abstract

Background

Chronic inflammation is increasingly recognized as a driver of residual cardiovascular risk, yet its integration into routine practice remains unclear.

Methods

A 20-item International Lipid Expert Panel (ILEP) online questionnaire, circulated March–October 2024, assessed healthcare professionals’ (HCPs) knowledge, perceptions, and practices regarding inflammation in atherosclerotic cardiovascular disease (ASCVD), with subgroup analyses by geography (Europe vs. US) and specialty (cardiology vs. other).

Results

453 HCPs from 58 countries responded. Nearly all (96.9%) regarded inflammation as a key mechanism of atherosclerosis, but this was not matched in practice: only about one-third routinely measured high-sensitivity C-reactive protein (hsCRP) and roughly 40% never did. Interpretation was inconsistent: 46.8% considered CRP itself causal, whereas only about one-fifth identified interleukin (IL)-6 as the causal mediator. Agents that lower hsCRP (statins, colchicine, bempedoic acid) were often equated with anti-inflammatory therapies (65.8%), and anti-inflammatory effects were incorrectly attributed to ezetimibe (24.1%) and PCSK9 inhibitors (38.1%). For elevated hsCRP, most respondents (72.4%) favoured intensifying lifestyle and background CVD therapy. In exploratory, unadjusted analyses, US respondents measured hsCRP more often (56.9%vs. 29.5%), were more likely to know recommended cutoffs (74.5%vs. 44.4%), and more frequently endorsed statins, colchicine, and bempedoic acid for elevated hsCRP (94.1%vs. 58.6%). HCPs specializing in cardiology outperformed other respondents on most items, including correct reference intervals and recognition of anti‑inflammatory drugs; they also more often intensified therapy for elevated hsCRP (78.3%vs. 67.5%), whereas other HCPs favored nutraceuticals or monitoring.

Conclusions

In this self-selected survey, there was a discordance between reported awareness of inflammation and its reported clinical use: routine hsCRP measurement was infrequent and the distinction between biomarkers and causal mediators was inconsistently understood, with exploratory differences by region and specialty. These hypothesis-generating findings support extensive, well-designed education to improve assessment and management of residual inflammatory risk.

Keywords

Ascvd; Awareness; Inflammation; Risk factor; Risk modifier; Survey

1. Introduction

Cardiovascular disease (CVD) continues to impose the highest burden of morbidity and mortality globally, yet despite optimal control of traditional risk factors, a substantial proportion of patients continue to experience major adverse cardiovascular events (MACE) [1,2]. Inflammation is now recognized as playing a pivotal role in the entire spectrum of atherosclerotic disease – from the initiation of endothelial dysfunction to plaque progression, destabilization and rupture [3,4].

High-sensitivity C-reactive protein (hsCRP), the most widely available inflammatory biomarker, is consistently associated with CV risk independently of low-density lipoprotein cholesterol (LDL-C) [5]. Evidence that inflammation is a modifiable target has since accumulated. Interleukin-1β (IL-1β) inhibition with canakinumab in the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), and low-dose colchicine in the Colchicine Cardiovascular Outcomes Trial (COLCOT) and the Low-Dose Colchicine (LoDoCo) trial, reduced CV events in patients with residual inflammatory risk; by contrast, methotrexate in the Cardiovascular Inflammation Reduction Trial (CIRT) showed no benefit, underscoring the need for pathway-specific inhibition [[6], [7], [8], [9]]. Reflecting these data, hsCRP and selected anti-inflammatory strategies (i.e. colchicine) are now featured in contemporary risk-stratification and dyslipidemia guidelines [10,11].

The extent to which this evidence has been translated into routine clinical practice, however, remains poorly characterized, particularly regarding the measurement of hsCRP, the interpretation of inflammatory biomarkers, and the management of patients with residual inflammatory risk. To address this question, the International Lipid Expert Panel (ILEP), in collaboration with American Society for Preventive Cardiology (ASPC), conducted an international survey of HCPs evaluating their knowledge, perceptions, and clinical use of inflammation-based risk assessment in ASCVD.

2. Methods

A 20-item survey (Supplemental Material), directed at healthcare professionals (HCPs) involved in CV prevention and lipid management, was developed by the ILEP Steering Committee. An initial draft, based on contemporary position papers and guidelines, was circulated for content review to 94 ILEP members on 16 February 2024; 32 (34%) responded and commented on item relevance, clarity, and completeness, providing an assessment of content validity. Based on this feedback the instrument was revised; items were reworded, and some merged or removed, to produce the final version. The revised questionnaire was pilot-tested with a convenience sample of six practising physicians (cardiologists and general practitioners) from Poland to check comprehension, question flow, technical correctness, skip logic, and completion time (range 12–17 min); only minor formatting and ordering changes were made before launch. Some questions (n = 4) from the survey allowed for multiple responses. Since the intended respondents were experienced English-proficient HCPs, the survey was administered in English only, without translation.

The final survey was hosted on the ILEP website and launched on 6 March 2024. It was disseminated through the ILEP and Polish Lipid Association (PoLA) webpages (ilep.eu; ptlipid.pl), targeted e-mails and newsletters (6011 recipients, sent three times), social media, and partner distribution via the American Society for Preventive Cardiology (ASPC; 3500 recipients, sent once). Among the 9511 directly invited recipients, 453 completed the survey, an approximate response proportion of 4.8%; because the questionnaire was also openly accessible through websites and social media, the total number of individuals who viewed the invitation could not be determined, and this figure should be regarded as approximate rather than a true response rate. An interim dataset of 264 complete responses (to 30 June 2024) was presented as an abstract at the American Heart Association Scientific Sessions (Chicago, November 2024). The survey closed on 22 October 2024. Participants were not randomly sampled and choose whether to take part; the resulting cohort therefore constitutes a self-selected convenience sample. Based on the responses, subgroup analyses by geography (European vs US HCPs) and specialty (in cardiology vs. other) were performed.

The online questionnaire evaluated HCPs’ knowledge, perceptions, and clinical practices regarding inflammation as a residual risk factor for ASCVD. It collected respondent demographics, assessed understanding of inflammatory mechanisms and biomarkers (particularly CRP/hsCRP), and explored the current use and perceived value of anti-inflammatory management strategies in routine care; four items allowed multiple responses. Participation was voluntary and anonymous; the platform prevented duplicate submissions and did not permit missing answers. Correct answers were pre-specified from the evidence-based literature available at launch, covering diagnosis, testing, biomarkers, diet, drugs, and management of inflammation-related conditions. Responses provide a cross-sectional snapshot of contemporary HCP awareness and management strategies related to CV inflammation.

The questionnaire was fully anonymous; no names, contact details, IP addresses, or other directly or indirectly identifying information were collected, and respondents could withdraw at any time before submission. As the study collected no identifiable data and did not constitute human-subjects research, it did not require ethics/institutional review board approval.

2.1. Statistical methods

All statistical analyses were performed using R software (version 4.5.2; R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were summarized as counts and percentages. Comparisons between European and US respondents and HSPs specializing in cardiology vs HCPs of other specialties were conducted using Pearson’s chi square test when all expected cell counts were ≥5. In cases where this assumption was not met, Fisher’s exact test was applied. For multiple response questions, each response option was coded as a separate binary variable (selected vs not-selected), and group differences were assessed individually for each option.

Proportions were calculated within each geographic region to allow direct comparison of response patterns. All tests were two sided, and a p value <0.05 was considered statistically significant. No adjustments were made for multiple comparisons, as the analyses were exploratory in nature. Results are presented as absolute numbers, percentages, and corresponding p values.

3. Results

3.1. Respondent characteristics

A total of 453 HCPs from 58 countries completed the survey over approximately seven months. Most were physicians (73.5%), among whom cardiologists formed the largest group, followed by emergency medicine, internal medicine, and family medicine specialists; researchers, residents/fellows, academics, and nurses accounted for the remainder. Respondents were predominantly male (59.8%) and aged 40 years or older (79%). Although 58 countries were represented, the geographic distribution was uneven: just over half of all responses (51.2%) came from only three countries; Poland (21.4%), Croatia (18.5%), and the USA (11.3%). Most respondents practised in large urban centres of more than 500,000 inhabitants (51.9%). Full respondent characteristics are shown in Table 1.

Table 1. Characteristics of the survey respondents.

Respondents’ characteristic (n = 453)n (%)
Age
 20–2923 (5.1)
 30–3972 (15.9)
 40–49121 (26.7)
 50–59108 (23.8)
 60–6986 (19.0)
 70–7939 (8.6)
 80+4 (0.9)
Sex
 Male271 (59.8)
 Female177 (39.1)
 Not responded5 (1.1)
Country
 Poland97 (21.4)
 Croatia84 (18.5)
 USA51 (11.3)
 Taiwan21 (4.6)
 Romania13 (2.9)
 France12 (2.6)
 Greece12 (2.6)
 Italy12 (2.6)
 Iraq10 (2.2)
 Lithuania9 (2.0)
 UK9 (2.0)
 Bulgaria8 (1.8)
 Argentina6 (1.3)
 Czechia6 (1.3)
 Hungary6 (1.3)
 Albania5 (1.1)
 Brazil5 (1.1)
 Canada5 (1.1)
 Russia5 (1.1)
 Turkey5 (1.1)
 Other*72 (15.9)
Domicile
 City >500 thousand inhabitants235 (51.9)
 City 100–500 thousand inhabitants90 (19.9)
 City 50–100 thousand inhabitants56 (12.4)
 City <50 thousand inhabitants57 (12.6)
 Village15 (3.3)
Occupation
 Physician333 (73.5)
 Resident/Fellow22 (4.9)
 Physician’s Assistant6 (1.3)
 Nurse7 (1.5)
 Public Health Specialist10 (2.2)
 Academic22 (4.9)
 Researcher26 (5.7)
 Other medical profession27 (6.0)
Specialty
 Cardiology207 (45.7)
 Family medicine45 (9.9)
 Emergency medicine65 (14.3)
 General/Internal medicine63 (13.9)
 Neurology9 (2.0)
 Surgery6 (1.3)
 Anesthesiology3 (0.7)
 Dermatology1 (0.2)
 Orthopedics and traumatology2 (0.4)
 Endocrinology16 (3.5)
 Diabetology14 (3.1)
 Gastroenterology3 (0.7)
 Nephrology11 (2.4)
 Other65 (14.3)
Inflammatory biomarker availability in practice⁎⁎
 Only CRP175 (38.6)
 hsCRP90 (19.9)
 CRP, hsCRP and IL-6
 None		77 (17.0)
76 (16.8)
 Other11 (2.4)

⁎

Other: Armenia (2), Australia (4), Chile (2), Colombia (3), Denmark (2), Dominican Republic (2), Egypt (3), Estonia (1), Ethiopia (1), Germany (2), India (4), Indonesia (1), Iran (1), Israel (1), Kyrgyzstan (1), Mexico (3), Myanmar (1), Netherlands (1), North Macedonia (1), Oman (1), Pakistan (3), Peru (1), Portugal (1), Saudi Arabia (1), Serbia (2), Singapore (1), Slovenia (3), South Africa (2), South Korea (1), Spain (3), Switzerland (3), Thailand (1), Uganda (1), Ukraine (4), UAE (2), Uzbekistan (2), Venezuela (2), Yemen (2).⁎⁎

Based on question 11, two additional responses not included in the table were: “I do not consider this important to improve risk estimation” (n = 14, 3.1%) and “I do not think it is important to measure inflammatory biomarkers before we have targeted drugs” (n = 10, 2.2%).

3.2. Knowledge of inflammatory mechanisms and biomarkers

Almost all respondents (96.9%) agreed that inflammation is a key mechanism of atherosclerosis, and 45.5% identified both inflammation and lipid disorders as central to the atherosclerotic process. The main pro-inflammatory mediators were recognized to varying degrees: IL-6 (79%), tumour necrosis factor-α (62.2%), the adhesion molecules intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 (47.1%), and IL-1β (44%). However, 46.8% of respondents incorrectly recognized CRP as a causal risk factor of CVD, with only 20.1% recognizing IL-6 as causal. Two-thirds of respondents (66.9%) correctly distinguished CRP from hsCRP, but only 51.7% identified the recommended hsCRP thresholds for CV risk stratification (Fig. 1).

Fig 1 dummy alt text

3.3. Use of hsCRP in clinical practice

Just over half of HCPs (51.7%) regarded hsCRP as a risk enhancer in primary prevention and a risk factor in secondary prevention, about one-third as an independent risk factor, and 17.4% considered the evidence still insufficient. Recognition of hsCRP ≥2 mg/L as a residual risk factor was high (74%), comparable to lipoprotein(a) (Lp(a)) and ahead of glycated hemoglobin (HbA1c) (68%) and LDL-C (63%). Despite this, routine use was limited: only 34.4% measured hsCRP routinely for risk stratification, while 40.4% never measured it. Access was also constrained, with only approximately one in six (17%) respondents being able to measure all three markers (CRP, hsCRP, and IL-6), and 38.6% having access to standard CRP only (Fig. 1).

3.4. Treatment and management choices

Regarding therapy, 65.8% correctly recognized that statins, colchicine, and bempedoic acid can lower hsCRP; 11.9% felt that only general CVD risk factors should be addressed, and about one in ten considered canakinumab the only effective option. Anti-inflammatory effects were most often attributed to statins (86.1%), colchicine (72.8%), canakinumab (58.5%), and bempedoic acid (51.8%), while 24.1% and 38.1% attributed them to ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) modulators, respectively, although neither is an established hsCRP-lowering therapy. Among statins, rosuvastatin (60.7%), atorvastatin (17.7%), and pitavastatin (7.5%) were considered the most potent anti-inflammatory agents.

In cases of elevated hsCRP, 72.4% of HCPs recommended intensification of lifestyle changes and background CVD therapies, while 9.5% preferred monitoring only, 9.1% suggested nutraceuticals, and 7.7% initiated colchicine. The most frequently indicated nutraceuticals were omega-3 fatty acids (60.4%), curcumin (59.7%) and garlic (47%).

3.5. Exploratory subgroup differences

Comparisons between regions and specialties should be regarded as exploratory, given the small US subgroup (n = 51), the higher concentration of European responses in a few countries, and the absence of adjustment for potential confounders. Agreement that inflammation is a central mechanism, and recognition of the main cytokines, did not differ between European (n = 295) and US (n = 51) respondents. US respondents measured hsCRP roughly twice as often (56.9%vs 29.5%) and more often knew the recommended cutoffs (74.5%vs 44.4%). They also far more often endorsed statins, colchicine, and bempedoic acid for lowering elevated hsCRP (94.1%vs 58.6%). European respondents more often had access only to standard CRP (48.8%vs 13.7%) and more often recommended nutraceuticals (9.5%vs 0.0%) or selected ezetimibe (28.8%vs 11.8%) (Table 2).

Table 2. Main differences between subgroups.

Europe (n = 295) vs US (n = 51)
Survey itemEuropeUSp-value
Routinely measures hsCRP29.5%56.9%0.007
Access limited to standard CRP48.8%13.7%<0.001
Access to CRP, hsCRP, and even IL 614.2%33.3%<0.001
Knows recommended hsCRP cut-offs44.4%74.5%<0.001
hsCRP classifies as a risk enhancer for primary prevention and risk factor for secondary prevention45.8%68.6%0.02
hsCRP classifies as an independent risk factor30.8%9.8%0.02
Recognizes hsCRP ≥ 2 mg/l as a residual risk factor68.8%86.3%0.017
Endorses statins/colchicine/bempedoic acid
to lower hsCRP		58.6%94.1%<0.001
Identifies colchicine as anti-inflammatory64.7%94.1%<0.001
Identifies canakinumab as anti-inflammatory52.2%80.4%<0.001
Identifies bempedoic acid as anti-inflammatory45.1%74.5%<0.001
Recommends nutraceuticals for elevated hsCRP9.5%0.0%0.022
HCPs specializing in cardiology (n = 207) vs Other (n = 246)
Survey itemCardiology SpecialtyOther
Specialty		p-value
Identifies IL-6 as a key pro-inflammatory cytokine86.5%72.4%<0.001
Identifies IL-1β as a pro-inflammatory key cytokine51.2%37.8%0.006
Distinguishes CRP from hsCRP72.5%62.2%0.019
Knows correct hsCRP reference intervals60.4%44.3%0.007
Recognizes LDL-C ≥ 100 mg/dl as a residual risk factor69.6%56.5%0.006
Recognizes hsCRP ≥2 mg/l as a residual risk factor80.7%67.9%0.003
Recognizes triglycerides ≥150 mg/dl as a residual risk factor70.5%49.2%<0.01
Recognizes hyperglycemia as a residual risk factor74.9%61.8%0.004
Identifies statins as anti-inflammatory94.2%78.9%<0.001
Identifies colchicine as anti-inflammatory88.9%58.9%<0.001
Identifies canakinumab as anti-inflammatory73.4%46.3%<0.001
Identifies bempedoic acid as anti-inflammatory59.4%45.1%0.003
Identifies apabetalone as anti-inflammatory2.4%7.3%0.031
Identifies ezetimibe as anti-inflammatory18.4%28.9%0.013
Intensifies lifestyle and background therapy
for elevated hsCRP		78.3%67.5%0.014
Prefers nutraceuticals5.3%12.2%0.017
Prefers monitoring only5.3%13.0%0.009

HCPs specializing in cardiology (n = 207) were more likely than others (n = 246) to give responses aligned with current evidence, including correct reference intervals (60.4%vs 44.3%), identification of drugs with anti-inflammatory effects (statins: 94.2% vs 78.9%, colchicine: 88.9% vs 58.9%, canakinumab: 3.4% vs 46.3%, and bempedoic acid: 59.4% vs 45.1%), and more often intensified therapy for elevated hsCRP (78.3%vs 67.5%), whereas other specialists more often favoured nutraceuticals or monitoring. No differences were observed between groups in recognizing hsCRP as a risk enhancer or independent CVD risk factor, in routine hsCRP measurement, in access to inflammatory biomarkers in practice, or in belief about documented anti‑inflammatory effects of selected nutraceuticals (Table 2).

Because region and specialty were not randomly assigned, these differences may partly reflect geography, age, practice setting, and self-selection. Detailed subgroup comparisons are provided in Table 2.

4. Discussion

In this first international survey evaluating HCPs’ awareness of inflammation as a residual CVD risk factor, nearly all respondents recognized inflammation as a fundamental mechanism of atherosclerosis. However, this conceptual understanding was only partially translated into clinical practice. Only one-third reported routinely measuring hsCRP, approximately 40% never measured it, and misconceptions about which biomarkers are causal and which therapies act on inflammation remained common. Together, these findings suggest that although the inflammatory paradigm of atherosclerosis is widely accepted, its practical application in CV risk assessment remains inconsistent.

This gap is clinically relevant because hsCRP is an established prognostic biomarker rather than solely a research tool. Elevated hsCRP (≥2 mg/L) is consistently associated with MACE, heart failure, and mortality, and is recognized in contemporary prevention guidelines as a risk-enhancing factor that can refine CVD risk assessment and support decisions regarding lipid-lowering therapy [[10], [11], [12], [13]]. Notably, nearly half of respondents regarded CRP as a causal mediator despite evidence indicating that the NOD-like receptor family pyrin domain containing 3 (NLRP3)–IL-1β–IL-6 signaling pathway represents the principal causal inflammatory axis in atherosclerosis [14]. Although this misconception is unlikely to alter immediate clinical management, it reflects an incomplete understanding of the biological rationale underpinning emerging anti-inflammatory therapies. In addition, limited access to hsCRP assays was frequently reported, indicating that underutilization reflects both educational and structural barriers. Respondents also appropriately identified Lp(a) as a residual CVD risk factor, consistent with current recommendations, although Lp(a) and hsCRP represent largely independent mechanisms contributing to residual CVD risk [15,16].

Treatment-related responses demonstrated similar uncertainty. While approximately two-thirds correctly recognized that statins, colchicine, and bempedoic acid reduce hsCRP concentrations, only 7.7% would initiate colchicine in patients with elevated hsCRP despite evidence supporting its use in selected patients with chronic coronary syndrome and its inclusion in contemporary European Society of Cardiology (ESC) and American College of Cardiology (ACC)/American Heart Association (AHA) recommendations [11,17,18]. This finding likely reflects uncertainty regarding patient selection and a lack of experience with the use of colchicine, rather than lack of awareness of colchicine itself. Respondents also frequently failed to distinguish therapies that reduce hsCRP indirectly from those exerting direct anti-inflammatory effects. Statins and bempedoic acid lower hsCRP largely secondary to lipid lowering, whereas ezetimibe and PCSK9 inhibitors do not have any significant effect on hsCRP, despite experimental links between PCSK9 and inflammatory pathways, and improve CV outcomes chiefly through LDL-C lowering [19]. Likewise, nearly one in ten respondents selected canakinumab despite the absence of regulatory approval or guideline recommendations for routine CV prevention [14]. Rosuvastatin was correctly identified by most respondents as the statin associated with the greatest hsCRP reduction, although a considerable minority selected atorvastatin, reflecting incomplete familiarity with comparative evidence [20,21]. The endorsement of nutraceuticals by a subset of respondents further illustrates the persistence of interventions that currently lack robust evidence for inflammation-targeted CV risk reduction [22].

Exploratory subgroup analyses demonstrated consistently greater familiarity with hsCRP among HCPs specializing in cardiology and respondents from the United States, who more frequently reported routine hsCRP measurement, identified recommended thresholds, and recognized evidence-based therapeutic strategies. Conversely, European responders and HCPs with other specialty more often relied on standard CRP testing or favored nutraceuticals. Because these analyses were based on self-selected respondents and were not adjusted for potential confounding factors, they should be interpreted cautiously and viewed as hypothesis-generating.

Overall, these findings suggest that improving implementation of inflammation-guided CV prevention requires more than increasing awareness of inflammation itself. Educational efforts should emphasize the distinction between hsCRP as a prognostic biomarker and IL-6 as the principal candidate causal mediator, while clearly differentiating therapies that reduce hsCRP from those with established anti-inflammatory indications. Equally important are practical recommendations defining when hsCRP should be measured, how elevated values should be incorporated into CV risk assessment, and which patients may benefit from inflammation-targeted treatment. Improving access to standardized hsCRP assays will also be necessary to facilitate broader implementation of these recommendations in routine clinical practice [23].

This study has several important limitations that should temper interpretation of its findings. First, the sample was neither random nor representative: participants constituted a self-selected convenience sample, recruited largely through professional societies devoted to prevention and lipidology, such as ILEP and ASPC. Clinicians engaged with these organizations are likely more interested in and knowledgeable about inflammation than the broader population of healthcare providers, so the survey may overestimate general awareness and guideline adoption. Second, the specialty mix was imbalanced. Nearly half of respondents were HCPs specializing in cardiology, whereas other specialties and non-physician professionals were under-represented, meaning the magnitude of knowledge gaps could differ across the full range of clinicians involved in CV care. Third, the geographic distribution was skewed. Although answers were collected from 58 countries, 40 percent of respondents came from Poland and Croatia, so important regions may not be adequately captured, limiting global generalizability. In this context, comparisons between European and US HCPs should be interpreted with caution, since the US sample is relatively small and the European sample is dominated by a few countries; therefore, regional comparisons should be considered exploratory. Fourth, although the survey was sent to 9511 directly invited recipients (an approximate response proportion of 4.8%), it was also openly accessible through websites and social media, so the total number of individuals who viewed the invitation – and therefore a precise response rate – could not be determined. Fifth, the analyses were exploratory and were not adjusted for multiple comparisons; accordingly, the reported p values should be interpreted as hypothesis-generating. Finally, the survey assessed self-reported knowledge and intended clinical practice rather than directly observed behaviour, which may not fully reflect actual clinical practice.

Central Illustration.

Unlabelled image dummy alt text

5. Conclusions

In this first international survey of HCPs, awareness of inflammation as a contributor to ASCVD risk was high, yet this knowledge was only partly reflected in clinical practice. Routine hsCRP measurement was uncommon, access to appropriate assays was frequently limited, and interpretation of inflammatory biomarkers was often inconsistent. The identified gaps were primarily conceptual; particularly distinguishing hsCRP as a prognostic biomarker from IL-6 as a candidate causal mediator and differentiating therapies that lower hsCRP from those with genuine anti-inflammatory effects. These findings highlight important educational priorities and support the need for clear, practical guidance on when and in whom inflammatory risk should be assessed, and how elevated hsCRP should inform clinical management. As this survey reflects a self-selected sample and describes current knowledge and practice rather than establishing clinical indications, defining the role of inflammation-guided risk assessment will require prospective diagnostic and outcome studies. Addressing these gaps may help translate the inflammatory paradigm of atherosclerosis into more consistent, evidence-based CV prevention.

Declaration of generative AI and AI-assisted technologies in the manuscript preparation process

During the preparation of this work, generative AI was used for creation of central illustration. The authors reviewed and edited the output as needed and take full responsibility for the content of the central illustration.

Funding

None.

CRediT authorship contribution statement

Maciej Banach: Writing – review & editing, Writing – original draft, Validation, Supervision, Investigation, Formal analysis, Data curation, Conceptualization. Alexandr Ceasovschih: Writing – review & editing, Writing – original draft. Stanislaw Surma: Writing – review & editing, Conceptualization. Fahad Alnouri: Writing – review & editing. G.B. John Mancini: Writing – review & editing. Dragos Vinereanu: Writing – review & editing. Hung-I Yeh: Writing – review & editing. Zeljko Reiner: Writing – review & editing. Pierre Sabouret: Writing – review & editing. Mutaz Al-Khnifsawi: Writing – review & editing. Gustavs Latkovskis: Writing – review & editing. Dan Gaita: Writing – review & editing. Arman Postadzhiyan: Writing – review & editing. Patrick M. Moriarty: Writing – review & editing. Branislav Vohnout: Writing – review & editing. Arrigo FG Cicero: Writing – review & editing. Jacek Jóźwiak: Writing – review & editing. Joanna Lewek: Writing – review & editing, Writing – original draft, Formal analysis. Michael D. Shapiro: Writing – review & editing, Writing – original draft, Supervision. Nathan D. Wong: Writing – review & editing, Supervision, Methodology, Data curation, Conceptualization.

Declaration of competing interest

MB has received research grant(s)/support from Amgen, Daiichi-Sankyo, Mylan/Viatris, Sanofi, and has received honoraria and/or served as a consultant for Adamed, Amgen, Berlin-Chemie/Menarini, Daiichi-Sankyo, Esperion, Kogen, KRKA, Lilly, MSD, Mylan/Viatris, NewAmsterdam Pharma, Novartis, Novo-Nordisk, Polpharma, Sanofi-Regeneron, Servier, Teva, and Zentiva; GBJM: Amgen, Sanofi, Novartis, HLS Therapeutics, Esperion, Ultragenyx, Novo Nordisk, Lilly, Boehringer Ingelheim, Merck; ŽR has received honoraria from Novartis and AstraZeneca; GL has given talks, attended conferences, received consultancy fees or participated in trials sponsored by Abbott Laboratories, Amgen, Astra-Zeneca, Berlin Chemie, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Grindex, KRKA, MSD, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier Laboratories, Siemens Laboratories, Zentiva, 89bio; AP has received honoraria and/or served as a consultant for Amgen, AstraZeneca, Gedeon Richter, MSD, Novartis, Novo-Nordisk, Polpharma, Servier, Teva, and Zentiva; MDS has the following research grants (to his institution) – Amgen, Boehringer Ingelheim, Cleerly, Novartis, Ionis, Lilly, Merck, New Amsterdam; serves on the following Scientific Advisory Boards: Amgen, Ionis, Esperion, Novartis, Regeneron, Lilly, Merck; and serves as a Consultant to: Novartis, Merck, Esperion, Astra Zeneca, Alnylam, Zip Bio, Mediwhale; all other authors have nothing to disclose.

Acknowledgments

No pharmaceutical company had any role in the writing of this original research. No external funding was used in the preparation of this manuscript.

Preliminary survey results were presented in an oral session at AHA 2024 in Chicago (16–18 Nov 2024; https://www.ahajournals.org/doi/abs/10.1161/circ.150.suppl_1.4141978), and the main results, including additional exploratory subanalyses comparing inflammation knowledge and awareness between U.S. and European physicians and between HSPs specializing in cardiology vs HCPs of other specialties, have been submitted for AHA 2026.

Appendix. Supplementary materials

Download: Download Word document (28KB)

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

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