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

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.