Skip to main content
  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

  • Home
  • About this Journal
    • Editorial Board
    • Meet the Editors
    • Editorial Manifesto
    • Impact Factor
    • Journal History
    • General Statistics
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Circulation Research Profiles
    • Trainees & Young Investigators
    • Research Around the World
    • News & Views
    • The NHLBI Page
    • Viewpoints
    • Compendia
    • Reviews
    • Recent Review Series
    • Profiles in Cardiovascular Science
    • Leaders in Cardiovascular Science
    • Commentaries on Cutting Edge Science
    • AHA/BCVS Scientific Statements
    • Abstract Supplements
    • Circulation Research Classics
    • In This Issue Archive
    • Anthology of Images
  • Resources
    • Online Submission/Peer Review
    • Why Submit to Circulation Research
    • Instructions for Authors
    • → Article Types
    • → Manuscript Preparation
    • → Submission Tips
    • → Journal Policies
    • Circulation Research Awards
    • Image Gallery
    • Council on Basic Cardiovascular Sciences
    • Customer Service & Ordering Info
    • International Users
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
  • Impact Factor 13.965
  • Facebook
  • Twitter

  • My alerts
  • Sign In
  • Join

  • Advanced search

Header Publisher Menu

  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

Circulation Research

  • My alerts
  • Sign In
  • Join

  • Impact Factor 13.965
  • Facebook
  • Twitter
  • Home
  • About this Journal
    • Editorial Board
    • Meet the Editors
    • Editorial Manifesto
    • Impact Factor
    • Journal History
    • General Statistics
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Circulation Research Profiles
    • Trainees & Young Investigators
    • Research Around the World
    • News & Views
    • The NHLBI Page
    • Viewpoints
    • Compendia
    • Reviews
    • Recent Review Series
    • Profiles in Cardiovascular Science
    • Leaders in Cardiovascular Science
    • Commentaries on Cutting Edge Science
    • AHA/BCVS Scientific Statements
    • Abstract Supplements
    • Circulation Research Classics
    • In This Issue Archive
    • Anthology of Images
  • Resources
    • Online Submission/Peer Review
    • Why Submit to Circulation Research
    • Instructions for Authors
    • → Article Types
    • → Manuscript Preparation
    • → Submission Tips
    • → Journal Policies
    • Circulation Research Awards
    • Image Gallery
    • Council on Basic Cardiovascular Sciences
    • Customer Service & Ordering Info
    • International Users
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
Viewpoints

CANTOS

A Gigantic Proof-of-Concept Trial

Borja Ibañez, Valentin Fuster
Download PDF
https://doi.org/10.1161/CIRCRESAHA.117.312200
Circulation Research. 2017;121:1320-1322
Originally published December 7, 2017
Borja Ibañez
From the Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (B.I., V.F.); Cardiology Department, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.); CIBER de enfermedades CardioVasculares, Madrid, Spain (B.I.); and Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.).
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Valentin Fuster
From the Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (B.I., V.F.); Cardiology Department, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain (B.I.); CIBER de enfermedades CardioVasculares, Madrid, Spain (B.I.); and Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (V.F.).
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics

Jump to

  • Article
    • Disclosures
    • Footnotes
    • References
  • Info & Metrics
  • eLetters
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.


  • atherosclerosis
  • biomarkers
  • C-reactive protein
  • cholesterol, LDL
  • inflammation

Cumulative evidence links inflammation with atherothrombotic disease. Conversely, the role of modulating the inflammatory process as a therapeutic target has remain an unproven hypothesis until the execution of the CANTOS trial (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study). On the one hand, this trial provides robust evidence that interleukin-1β (IL-1β) inhibition by canakinumab reduces the incidence of repetitive atherothrombotic events in patients with postmyocardial infarction already on state-of-the-art treatment but with a residual inflammatory risk. On the other hand, the absolute antiatherothrombotic effect size of this intervention seems small (189 patients had to be intervened during 1 year to prevent 1 myocardial infarction episode) and associated with a mild increase in the incidence of serious adverse events (≈1 in 750 patients intervened during 1 year developed a fatal infection or sepsis). Beyond all these considerations, CANTOS represents a gigantic (10 000 patients) proof-of-concept trial.

Atherosclerosis is a systemic disease with a long clinically silent phase. Arterial wall lipid deposition, the hallmark of atherosclerosis, begins early in life. Atherosclerotic plaques grow gradually for several years, the disease becoming clinically overt only when the plaque is large enough to restrict blood flow or becomes unstable and ruptures, causing a thrombus. From its earliest asymptomatic phase through to the late clinical manifest stages, atherosclerosis is predominantly an inflammatory disease, featuring leukocyte activation, cytokine release, and infiltration by eosinophils, neutrophils, and macrophages. Epidemiological studies have revealed that circulating inflammatory biomarkers, especially C-reactive protein (CRP) measured by a high sensitivity (hs) assay, are associated with a higher incidence of atherothrombotic events (myocardial infarction, stroke, etc.).1 All these observations suggested that strategies to reduce inflammation would lead to a reduction in atherothrombotic events. However, it is important to note that the evidence linking inflammation to atherosclerosis is associative, and evidence for a causal role of inflammation in atherothrombotic …

View Full Text

American Heart Association Professional?

Log in with your Professional Heart Daily username and password. Not an American Heart Association Professional? Continue below.

Log in using your username and password

Enter your Circulation Research username.
Enter the password that accompanies your username.
Forgot your user name or password?

Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$35.00

Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.

Back to top
Previous ArticleNext Article

This Issue

Circulation Research
December 8, 2017, Volume 121, Issue 12
  • Table of Contents
Previous ArticleNext Article

Jump to

  • Article
    • Disclosures
    • Footnotes
    • References
  • Info & Metrics

Article Tools

  • Print
  • Citation Tools
    CANTOS
    Borja Ibañez and Valentin Fuster
    Circulation Research. 2017;121:1320-1322, originally published December 7, 2017
    https://doi.org/10.1161/CIRCRESAHA.117.312200

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
  • Article Alerts
    Log in to Email Alerts with your email address.
  • Save to my folders

Share this Article

  • Email

    Thank you for your interest in spreading the word on Circulation Research.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    CANTOS
    (Your Name) has sent you a message from Circulation Research
    (Your Name) thought you would like to see the Circulation Research web site.
  • Share on Social Media
    CANTOS
    Borja Ibañez and Valentin Fuster
    Circulation Research. 2017;121:1320-1322, originally published December 7, 2017
    https://doi.org/10.1161/CIRCRESAHA.117.312200
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo

Related Articles

Cited By...

Subjects

  • Basic, Translational, and Clinical Research
    • Inflammation
  • Vascular Disease
    • Atherosclerosis
    • Acute Coronary Syndromes

Circulation Research

  • About Circulation Research
  • Editorial Board
  • Instructions for Authors
  • Abstract Supplements
  • AHA Statements and Guidelines
  • Permissions
  • Reprints
  • Email Alerts
  • Open Access Information
  • AHA Journals RSS
  • AHA Newsroom

Editorial Office Address:
3355 Keswick Rd
Main Bldg 103
Baltimore, MD 21211
CircRes@circresearch.org

Information for:
  • Advertisers
  • Subscribers
  • Subscriber Help
  • Institutions / Librarians
  • Institutional Subscriptions FAQ
  • International Users
American Heart Association Learn and Live
National Center
7272 Greenville Ave.
Dallas, TX 75231

Customer Service

  • 1-800-AHA-USA-1
  • 1-800-242-8721
  • Local Info
  • Contact Us

About Us

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. The need for our work is beyond question. Find Out More about the American Heart Association

  • Careers
  • SHOP
  • Latest Heart and Stroke News
  • AHA/ASA Media Newsroom

Our Sites

  • American Heart Association
  • American Stroke Association
  • For Professionals
  • More Sites

Take Action

  • Advocate
  • Donate
  • Planned Giving
  • Volunteer

Online Communities

  • AFib Support
  • Garden Community
  • Patient Support Network
  • Professional Online Network

Follow Us:

  • Follow Circulation on Twitter
  • Visit Circulation on Facebook
  • Follow Circulation on Google Plus
  • Follow Circulation on Instagram
  • Follow Circulation on Pinterest
  • Follow Circulation on YouTube
  • Rss Feeds
  • Privacy Policy
  • Copyright
  • Ethics Policy
  • Conflict of Interest Policy
  • Linking Policy
  • Diversity
  • Careers

©2018 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The American Heart Association is a qualified 501(c)(3) tax-exempt organization.
*Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark.

  • PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program
  • BBB Accredited Charity
  • Comodo Secured