Low-Grade Chronic Inflammation and Atherosclerotic Cardiovascular Risk: The Beneficial Role of Specific Nutritional Approaches

Healthy nutrition is pivotal for the prevention of atherosclerotic cardiovascular disease (ASCVD). In addition to traditional risk factors, other components, like low-grade chronic inflammation, play a pathogenetic role in ASCVD. Research efforts aim to identify low-grade chronic inflammation in patients with established ASCVD and in subjects with low ASCVD risk, and to validate effective nutritional strategies. Here, current nutritional approaches to counteract low-grade chronic inflammation related to ASCVD and possibly mitigated ASCVD risk are discussed, along with related molecular pathways and clinical biomarkers. Low-grade chronic inflammation results from a pro-inflammatory response promoted by large multiprotein complexes (inflammasomes). Within the ASCVD context, the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome is the most characterized protein complex, whose activation leads to increased release of downstream effectors (interleukin (IL)-1β, IL-18, IL-6). In the current clinical practice, high-sensitivity C-reactive protein (hsCRP) is used as a circulating biomarker for systemic inflammation, although it is not univocally associated with ASCVD. Some nutritional strategies have been shown effective to mitigate low-grade chronic inflammation and to reduce hsCRP, reducing in some cases ASCVD risk. The Mediterranean Diet and related trials showed that their beneficial effects on cardiovascular disorders could also be related to the anti-inflammatory properties of specific active compounds. Contradictory results have also been obtained, due to lack of standardization and to the specific nature of nutritional studies, which often rely on adherence and compliance of participants. Given the relevance of low-grade chronic inflammation for ASCVD risk, future work will need to increase awareness, identify and validate novel biomarkers, and implement novel effective nutrition strategies.