Review ArticlesTherapeutic Role of Innovative Anti-Inflammatory Medications in the Prevention of Acute Coronary SyndromePashun, Raymond Anthony MD*; Frishman, William H. MD†Author Information From the *Department of Medicine, New York Presbyterian Hospital, Cornell Medical Center, New York, NY; and †Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY. The authors declare there are no conflicts of interest in the preparation of this manuscript. Correspondence: William H. Frishman, MD, Department of Medicine, New York Medical College, Valhalla, NY 10595. E-mail: William_Frishman@nymc.edu. Cardiology in Review: September/October 2015 - Volume 23 - Issue 5 - p 252-260 doi: 10.1097/CRD.0000000000000062 Buy Metrics Abstract An improved understanding of the pathogenesis of acute coronary syndromes and its relationship to atherosclerotic plaque rupture and thrombosis has contributed to the investigation of novel therapies for prevention and treatment. New data ascribe an increasingly important role of active inflammation in contributing to thinning of the atherosclerotic fibrous cap and plaque instability. Despite this understanding, there are currently no therapeutic approaches to specifically target the unstable plaque. Multiple randomized trials investigating treatment strategies have recently been completed or are currently being conducted, using anti-inflammatory medications, such as methotrexate, colchicine, darapladib, varespladib, losmapimod, and canakinumab, to reduce the incidence of cardiovascular events including acute coronary syndromes. These anti-inflammatory medications differ in their mechanism of action from having widespread targets (as is the case for methotrexate and colchicine) to having specific targets (as is the case for darapladib, varespladib, losmapimod, and canakinumab). The trials investigating the efficacy of darapladib in reducing cardiovascular events revealed no significant benefit when compared with the current standard of care. The varespladib studies were terminated early because of adverse outcomes. However, the outcomes of the remaining drug studies may still contribute to novel therapeutic approaches in the treatment of patients with unstable coronary artery disease. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.