This review investigates the central role of inflammation in atherosclerosis, the chronic inflammatory disease underlying cardiovascular morbidity and mortality. The aim is to summarize the current knowledge about the role of inflammation in atherosclerosis and the therapeutic strategies against inflammation. A systematic review was performed in PubMed, Scopus, and Web of Science articles between 2010 and December 2024. Thirty-six studies focusing on inflammatory pathways, biomarkers, and anti-inflammatory therapy for treatment in clinical trials were included in the search. The principal findings have been that oxidised low-density lipoprotein (LDL) promotes endothelial dysfunction leading to EmD, by inducing an inflammatory cascade with monocytes, macrophages and T-cells involvement. Pro-inflammatory cytokines, including IL-1β and TNF-α play a part in exacerbating plaque progression, with CRP used as a clinical marker. Canakinumab Anti-inflammatory therapies such as canakinumab may be beneficial in decreasing cardiovascular (CV) events but the delicate balance between efficacy and safety is yet to be established. The review points out that the therapeutic potential for the manipulation of these pathways is low-hanging fruit, but notes that gaps in the knowledge base and conflicting reports on long-term outcomes and patient-specific responses call for further research. Ongoing future strategies include personalized medicine and new antimediatory agents to enhance clinical outcome.