The Interplay of Lipids, Lipoproteins, and Immunity in Atherosclerosis

  • Angela Pirillo
  • Fabrizia Bonacina
  • Giuseppe Danilo Norata
  • Alberico Luigi Catapano
Evidence-Based Medicine (L. Roever, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Evidence Based Medicine


Purpose of Review

Atherosclerosis is an inflammatory disorder of the arterial wall, in which several players contribute to the onset and progression of the disease. Besides the well-established role of lipids, specifically cholesterol, and immune cell activation, new insights on the molecular mechanisms underlying the atherogenic process have emerged.

Recent Findings

Meta-inflammation, a condition of low-grade immune response caused by metabolic dysregulation, immunological memory of innate immune cells (referred to as “trained immunity”), cholesterol homeostasis in dendritic cells, and immunometabolism, i.e., the interplay between immunological and metabolic processes, have all emerged as new actors during atherogenesis. These observations reinforced the interest in directly targeting inflammation to reduce cardiovascular disease.


The novel acquisitions in pathophysiology of atherosclerosis reinforce the tight link between lipids, inflammation, and immune response, and support the benefit of targeting LDL-C as well as inflammation to decrease the CVD burden. How this will translate into the clinic will depend on the balance between costs (monoclonal antibodies either to PCSK9 or to IL-1ß), side effects (increased incidence of death due to infections for anti-IL-1ß antibody), and the benefits for patients at high CVD risk.


Atherosclerosis Cholesterol Inflammation Immune response 


Compliance with Ethical Standards

Conflict of Interest

Angela Pirillo and Fabrizia Bonacina declare no conflict of interest.

Giuseppe Danilo Norata reports grants from Pfizer, personal fees from Sanofi, Aegerion, Amgen, Alnylam, Novartis, outside the submitted work. Alberico Luigi Catapano reports grants from Pfizer, Sanofi, Regeneron, Merck, Mediolanum, SigmaTau, Menarini, kowa, Recordati, Eli Lilly, and personal fees from Astrazeneca, Genzyme, Bayer SigmaTau, Menarini, kowa, Eli Lilly, Recordati, Pfizer, Sanofi, Mediolanum, Pfizer, Merck, Sanofi, Aegerion, and Amgen, outside the submitted work. The work of the authors is supported by: Fondazione Cariplo 2015-0524 and 2015-0564 (ALC), and 2016-0852 (GDN); H2020 REPROGRAM PHC-03-2015/667837-2 (ALC); Telethon Foundation (GGP13002) (GDN), Ministero della Salute GR-2011-02346974 (GDN) and GR-2013-02355011 (FB); Aspire Cardiovascular Grant 2016-WI218287 (GDN).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Angela Pirillo
    • 1
    • 2
  • Fabrizia Bonacina
    • 3
  • Giuseppe Danilo Norata
    • 3
    • 4
  • Alberico Luigi Catapano
    • 2
    • 3
    • 5
  1. 1.Center for the Study of AtherosclerosisBassini HospitalMilanItaly
  2. 2.IRCCS MultimedicaMilanItaly
  3. 3.Department of Pharmacological and Biomolecular SciencesUniversità degli Studi di MilanoMilanItaly
  4. 4.School of Biomedical Sciences, Curtin Health Innovation Research InstituteCurtin UniversityPerthAustralia
  5. 5.Department of Pharmacological and Biomolecular SciencesUniversity of Milan and IRCCS MultimedicaMilanItaly

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