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Tang X, Zhang Y, Wang T, Ma Y, Shi H, Yin R, Zou P, Cao J, Pan C. Image quality and diagnostic accuracy of different dosages of iodixanol in computed tomography angiography and perfusion of overweight patients with coronary artery stenosis: A feasibility study. Med Eng Phys 2022; 110:103818. [PMID: 35618562 DOI: 10.1016/j.medengphy.2022.103818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Iodixanol contrast media with different doses using computed tomography angiography (CTA) and perfusion (CTP) to diagnose coronary artery disease (CAD) in overweight patients lacks assessment. Our study compared iodixanol 320 mg I/ml and 270 mg I/ml on image quality and accuracy of CTA combined CTP (CTA-CTP) to diagnose CAD. METHODS Overweight patients with suspected of CAD were randomized into iodixanol 270 group (received iodixanol 270 mg I/ml) and iodixanol 320 group (received iodixanol 320 mg I/ml). Based on these characteristics data, receiver operating characteristic (ROC) curve and corresponding area under the curve (AUC) were plotted to assess the sensitivity and specificity of the two administrations. RESULTS The subjective definition score, signal to noise ratio, and CT value of aorta in iodixanol 320 group were higher than iodixanol 270 group. In iodixanol 270 group: the image exhibited a normal state of both vessels and myocardial perfusion; and the AUC, specificity, and sensitivity were 0.376, 66.67, and 80.46, respectively. In iodixanol 320 group: the image exhibited a diameter stenosis in right coronary artery and myocardial infarction of inferior wall and proximal inferior wall septum, as well as myocardial perfusion defects; and the AUC, specificity, and sensitivity in iodixanol 320 group were 0.824, 75.00, and 89.87, respectively. CONCLUSION Accuracy and image quality of iodixanol 320 mg I/ml in the diagnosis of CAD with CTA-CTP was higher than using iodixanol 270 mg I/ml.
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Affiliation(s)
- Xiaoqiang Tang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Yong Zhang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Tao Wang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Yi Ma
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Ruohan Yin
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Ping Zou
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Jian Cao
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Changjie Pan
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China.
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Abstract
Atherosclerosis is considered a chronic, inflammatory disease responsible for more than 15% of all global deaths, secondary to its complications of myocardial infarction, vascular disease, and stroke. Current treatment regimens consist of lipid-lowering pharmaceuticals, control of risk factors, and prevention of plaque rupture and thrombosis with antiplatelet agents. However, a significant burden on society remains due to the morbidity and mortality of coronary artery disease despite our best practices. In addition to dyslipidemia and hemostasis, inflammation has now moved to the proverbial forefront as the remaining obstacle to appropriate management of atherosclerosis. A complex dance of endothelial dysfunction, complement activation, and immune cell-mediated cytokine release underlie the pathogenesis of atherosclerotic plaque development, destabilization, and rupture. Cholesterol-induced sterile inflammation is thought to be central to this process via activation of a protein complex called the nucleotide-binding oligomerization domain-, leucine-rich repeat- and pyrin domain-containing 3 (NLRP3) inflammasome. The focus of this review article will be to examine the NLRP3 inflammasome, which directs the release of interleukin-1, leading to downstream pro-inflammatory effects, and its potential for therapeutic targeting using currently available and future tools in our pharmacologic arsenal. In particular, we focus on the results of several large, recently concluded clinical trials including the Canakinumab Antiinflammatory Thrombosis Outcome Study, Colchicine Cardiovascular Outcomes Trial, and the Low-Dose Colchicine Study, examining the efficacy of direct inhibition of interleukin-1 with canakinumab or a multimodal approach to inhibiting the NLRP3 inflammasome using colchicine, as well as an overview of novel small molecule inhibitors that are still in development.
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Affiliation(s)
- Gregory Hemenway
- From the Department of Medicine, Temple University Hospital, Philadelphia, PA
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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Martinez-Moreno A, Ocampo-Candiani J, Garza-Rodriguez V. Psoriasis and Cardiovascular Disease: A Narrative Review. Korean J Fam Med 2021; 42:345-355. [PMID: 32512983 PMCID: PMC8490176 DOI: 10.4082/kjfm.20.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a chronic, autoimmune, and inflammatory disease that affects 2% of the world's population. In recent years, it has been demonstrated that psoriasis confers a 25% increase in relative risk of cardiovascular disease, independent of factors such as hyperlipidemia, smoking, and obesity. The objective of this review was to analyze and describe the association between psoriasis and cardiovascular disease. In this review, we describe the epidemiological association of psoriasis and cardiovascular disease, pathophysiology, mechanisms, and its association with the well-known cardiovascular risk calculators. In addition, we describe diagnostic tools, such as imaging techniques and novel biomarkers, that are useful in the evaluation of atherosclerotic cardiovascular disease. Finally, we present different systemic therapies that are used in patients with psoriasis and their effect on atherosclerotic cardiovascular disease. This article provides an overview of the current literature on psoriasis and cardiovascular risk, which can be useful for primary care physicians in their daily clinical practice.
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Affiliation(s)
- Adrian Martinez-Moreno
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Veronica Garza-Rodriguez
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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4
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Opstal TSJ, Fiolet ATL, van Broekhoven A, Mosterd A, Eikelboom JW, Nidorf SM, Thompson PL, Duyvendak M, van Eck JWM, van Beek EA, den Hartog F, Budgeon CA, Bax WA, Tijssen JGP, El Messaoudi S, Cornel JH. Colchicine in Patients With Chronic Coronary Disease in Relation to Prior Acute Coronary Syndrome. J Am Coll Cardiol 2021; 78:859-866. [PMID: 34446156 DOI: 10.1016/j.jacc.2021.06.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Colchicine reduces risk of cardiovascular events in patients post-myocardial infarction and in patients with chronic coronary disease. It remains unclear whether this effect is related to the time of onset of treatment following an acute coronary syndrome (ACS). OBJECTIVES This study investigates risk for major adverse cardiovascular events in relation to history and timing of prior ACS, to determine whether the benefits of colchicine are consistent independent of prior ACS status. METHODS The LoDoCo2 (Low-Dose Colchicine 2) trial randomly allocated patients with chronic coronary disease to colchicine 0.5 mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed. RESULTS In 5,522 randomized patients, risk of the primary endpoint was independent of prior ACS status. Colchicine consistently reduced the primary endpoint in patients with no prior ACS (incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4 vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI: 0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100 person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59). CONCLUSIONS The benefits of colchicine are consistent irrespective of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose Colchicine for secondary prevention of cardiovascular disease [LoDoCo2] ACTRN12614000093684).
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Affiliation(s)
- Tjerk S J Opstal
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands.
| | - Aernoud T L Fiolet
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Dutch Network for Cardiovascular Research, Utrecht, the Netherlands
| | - Amber van Broekhoven
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arend Mosterd
- Dutch Network for Cardiovascular Research, Utrecht, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stefan M Nidorf
- Heart and Vascular Research Institute of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; GenesisCare Western Australia, Perth, Western Australia, Australia
| | - Peter L Thompson
- Heart and Vascular Research Institute of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia
| | - Michiel Duyvendak
- Department of Clinical Pharmacy, Antonius Hospital Sneek, Sneek, the Netherlands; Pharmacy D&A Research, Sneek, the Netherlands
| | - J W Martijn van Eck
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Eugène A van Beek
- Department of Cardiology, St Jansdal Hospital, Harderwijk, the Netherlands
| | - Frank den Hartog
- Department of Cardiology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Charley A Budgeon
- University of Western Australia, Perth, Western Australia, Australia
| | - Willem A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Cardialysis BV, Rotterdam, the Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan H Cornel
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands; Dutch Network for Cardiovascular Research, Utrecht, the Netherlands
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5
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Cantrell MS, Soto-Avellaneda A, Wall JD, Ajeti AD, Morrison BE, Warner LR, McDougal OM. Repurposing Drugs to Treat Heart and Brain Illness. Pharmaceuticals (Basel) 2021; 14:ph14060573. [PMID: 34208502 PMCID: PMC8235459 DOI: 10.3390/ph14060573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Drug development is a complicated, slow and expensive process with high failure rates. One strategy to mitigate these factors is to recycle existing drugs with viable safety profiles and have gained Food and Drug Administration approval following extensive clinical trials. Cardiovascular and neurodegenerative diseases are difficult to treat, and there exist few effective therapeutics, necessitating the development of new, more efficacious drugs. Recent scientific studies have led to a mechanistic understanding of heart and brain disease progression, which has led researchers to assess myriad drugs for their potential as pharmacological treatments for these ailments. The focus of this review is to survey strategies for the selection of drug repurposing candidates and provide representative case studies where drug repurposing strategies were used to discover therapeutics for cardiovascular and neurodegenerative diseases, with a focus on anti-inflammatory processes where new drug alternatives are needed.
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Affiliation(s)
- Maranda S. Cantrell
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Alejandro Soto-Avellaneda
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Department of Biology, Boise State University, Boise, ID 83725, USA
| | - Jackson D. Wall
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Aaron D. Ajeti
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Brad E. Morrison
- Department of Biology, Boise State University, Boise, ID 83725, USA
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
| | - Lisa R. Warner
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
| | - Owen M. McDougal
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
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6
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Szwed P, Gąsecka A, Zawadka M, Eyileten C, Postuła M, Mazurek T, Szarpak Ł, Filipiak KJ. Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications. J Clin Med 2021; 10:2539. [PMID: 34201137 PMCID: PMC8229654 DOI: 10.3390/jcm10122539] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/11/2022] Open
Abstract
Atherosclerotic cardiovascular diseases (ASCVD) are the major cause of mortality worldwide. Despite the continuous progress in ASCVD therapy, the residual risk persists beyond the management of traditional risk factors. Several infections including Helicobacter pylori infection, periodontal disease, and viral infections are associated with the increased risk of ASCVD, both directly by damage to the heart muscle and vasculature, and indirectly by triggering a systemic proinflammatory state. Hence, beyond the optimal management of the traditional ASCVD risk factors, infections should be considered as an important non-classical risk factor to enable early diagnosis and appropriate treatment. Here, we summarized the currently available evidence regarding the role of inflammation in ASCVD and the association between the particular infections and pathogens (Helicobacter pylori, periodontal disease, pneumonia, Cytomegalovirus, Human immunodeficiency virus, Herpes simplex virus, and severe acute respiratory syndrome coronavirus 2) on the development and progression of ASCVD. We also speculated about the potential therapeutic implications of the anti-inflammatory and anti-infective drugs on ASCVD outcomes, including drugs routinely administered in patients with ASCVD (statins, P2Y12 receptor inhibitors, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) and novel strategies aiming at residual risk reduction (colchicine, anti-cytokine drugs, and methotrexate). Considering the emerging association between infections and ASCVD, it is crucial to determine the possible advantages of infection prevention and treatment in patients with ASCVD.
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Affiliation(s)
- Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.S.); (T.M.); (K.J.F.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.S.); (T.M.); (K.J.F.)
| | - Mateusz Zawadka
- 2nd Department of Anaestesiology and Intensive Therapy, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology Medical University of Warsaw, 02-097 Warsaw, Poland; (C.E.); (M.P.)
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology Medical University of Warsaw, 02-097 Warsaw, Poland; (C.E.); (M.P.)
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.S.); (T.M.); (K.J.F.)
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, 03-411 Warsaw, Poland;
- Maria Sklodowska-Curie Bialystok Oncology Center, 02-034 Bialystok, Poland
| | - Krzysztof J. Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.S.); (T.M.); (K.J.F.)
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7
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Xiang Z, Yang J, Yang J, Zhang J, Fan Z, Yang C, Di L, Ma C, Wu J, Huang Y. Efficacy and safety of colchicine for secondary prevention of coronary heart disease: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:487-496. [PMID: 33400158 DOI: 10.1007/s11739-020-02606-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/12/2020] [Indexed: 01/28/2023]
Abstract
To evaluate the efficacy and safety of colchicine for secondary prevention of coronary heart disease (CHD), relevant randomized controlled trials (RCTs) were identified by searching several databases from the creation date to August 31, 2020 and were reviewed. Eight eligible trials of colchicine therapy involving a total of 11, 463 patients were included (5, 776 subjects received colchicine, while 5, 687 subjects were in the respective control arms), and the outcome was reported as risk ratio (RR) and 95% confidence interval (CI), as the relative measure of association. Overall, the incidences of major adverse cardiovascular events (MACEs) (RR 0.70; 95% CI 0.61-0.80), myocardial infarction (MI) (RR 0.77; 95% CI 0.64-0.94), emergency readmission due to CHD (RR 0.70; 95% CI 0.58-0.86), and ischemic stroke (RR 0.49; 95% CI 0.30-0.79) were lower in the colchicine group than in the placebo arm. We did not find a significant reduction in the incidence of all-cause mortality (RR 1.03; 95% CI 0.80-1.32). Although the incidence of diarrhea in the colchicine treatment group was higher than that in the placebo arms (RR 2.53; 95% CI 1.17, 5.48), the symptoms disappeared rapidly after drug withdrawal, and no serious adverse reactions occurred. In summary, colchicine is an accessible, safe, and effective drug that could be successfully utilized for the secondary prevention of CHD. The tolerability and benefits should be confirmed in in-depth clinical trials.
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Affiliation(s)
- Zujin Xiang
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China
| | - Jian Yang
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China.
| | - Jun Yang
- The First Clinical Medical College of China, Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei, China
| | - Jing Zhang
- The First Clinical Medical College of China, Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei, China
| | - Zhixing Fan
- The First Clinical Medical College of China, Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei, China
| | - Chaojun Yang
- The First Clinical Medical College of China, Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei, China
| | - Liu Di
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China
| | - Cong Ma
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China
| | - Jingyi Wu
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China
| | - Yifan Huang
- The first People's Hospital of Yichang, The People's Hospital of China, Three Gorges University, Yichang, 443000, Hubei, China
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8
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Xia M, Yang X, Qian C. Meta-analysis Evaluating the Utility of Colchicine in Secondary Prevention of Coronary Artery Disease. Am J Cardiol 2021; 140:33-38. [PMID: 33137319 DOI: 10.1016/j.amjcard.2020.10.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 01/17/2023]
Abstract
Colchicine has shown potential therapeutic benefits in cardiovascular conditions owing to its broad anti-inflammatory properties. Here, we performed a meta-analysis to determine the efficacy and safety of colchicine in patients with coronary artery disease (CAD). A systematical search in electronic databases of PubMed, The Cochrane Library, and Scopus were carried out to identify eligible studies. Only randomized controlled trials evaluating the cardiovascular effects of colchicine in CAD patients were included. Study-level data of cardiovascular outcomes or adverse events were pooled using random-effect models. We finally included 5 randomized controlled trials with follow-up duration ≥6 months, comprising a total of 11,790 patients with CAD. Compared with placebo or no treatment, colchicine administration was associated with a significantly lower incidence of major adverse cardiovascular events (relative risk [RR] 0.65, 95% confidence interval [CI] 0.52 to 0.82). Such a benefit was not modified by the clinical phenotype of CAD (p for interaction = 0.34). Colchicine treatment also decreased the risk of myocardial infarction (RR 0.73, 95% CI 0.55 to 0.98), coronary revascularization (RR 0.61, 95% CI 0.42 to 0.89) and stroke (RR 0.47, 95% CI 0.28 to 0.81) in CAD patients, but with no impact on cardiovascular mortality. In addition, the rates of common adverse events were generally similar between colchicine and control groups, including noncardiovascular deaths (RR 1.50, 95% CI 0.93 to 2.40) and gastrointestinal symptoms (RR 1.05, 95% CI 0.91 to 1.22). In conclusion, the results of our meta-analysis demonstrated that colchicine treatment may reduce the risk of future cardiovascular events in CAD patients.
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9
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Hansildaar R, Vedder D, Baniaamam M, Tausche AK, Gerritsen M, Nurmohamed MT. Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout. THE LANCET. RHEUMATOLOGY 2021; 3:e58-e70. [PMID: 32904897 PMCID: PMC7462628 DOI: 10.1016/s2665-9913(20)30221-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The increased risk of cardiovascular morbidity and mortality in rheumatoid arthritis and gout has been increasingly acknowledged in past decades, with accumulating evidence that gout, just as with rheumatoid arthritis, is an independent cardiovascular risk factor. Although both diseases have a completely different pathogenesis, the underlying pathophysiological mechanisms in systemic inflammation overlap to some extent. Following the recognition that systemic inflammation has an important causative role in cardiovascular disease, anti-inflammatory therapy in both conditions and urate-lowering therapies in gout are expected to lower the cardiovascular burden of patients. Unfortunately, much of the existing data showing that urate-lowering therapy has consistent beneficial effects on cardiovascular outcomes in patients with gout are of low quality and contradictory. We will discuss the latest evidence in this respect. Cardiovascular disease risk management for patients with rheumatoid arthritis and gout is essential. Clinical guidelines and implementation of cardiovascular risk management in daily clinical practice, as well as unmet needs and areas for further investigation, will be discussed.
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Affiliation(s)
- Romy Hansildaar
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Daisy Vedder
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Milad Baniaamam
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Martijn Gerritsen
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam and Reade, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
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10
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Whayne TF. Inflammation May be the Future of Cardiovascular Risk Reduction: Does Colchicine have a Current Indication? Am J Cardiovasc Drugs 2021; 21:1-10. [PMID: 32356107 DOI: 10.1007/s40256-020-00408-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Inflammation as a cardiovascular risk factor has attracted increasing attention . The current standard of care for decreasing the occurrence of cardiovascular events includes controlling risk factors such as hypertension and maximizing the lowering of low-density lipoprotein cholesterol (LDL-C). However, a recent study demonstrated decreased cardiovascular risk with the anti-inflammatory agent canakinumab and created more interest in decreasing cardiovascular risk by decreasing inflammation. Canakinumab is not yet approved and will undoubtedly be very expensive, so interest in an established medication such as colchicine, which is inexpensive to produce, is appropriate if evidence-based benefit is adequately confirmed. Colchicine has existing indications for gout and familial Mediterranean fever and for decreasing the incidence of postpericardiotomy syndrome. If an evidence-based benefit in decreasing cardiovascular risk can be demonstrated for colchicine, it will be of significant importance. Meta-analyses and observational studies have provided evidence to suggest that colchicine decreases cardiovascular risk because of its anti-inflammatory effects. However, randomized controlled trials (RCTs) are needed, and the recently published COLCOT (Colchicine Cardiovascular Outcomes Trial) showed definite benefit on cardiovascular outcomes in adults who had experienced a myocardial infarction within the previous 30 days. Sufficient evidence now supports the use of colchicine for secondary prevention in patients at the highest cardiovascular risk who continue to have cardiovascular events despite good blood pressure control and maximum LDL-C reduction. Nevertheless, more RCTs will be necessary before widespread general use of colchicine in cardiovascular disease prevention can be recommended. The current acquisition cost issues with colchicine also need to be resolved.
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Affiliation(s)
- Thomas F Whayne
- Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.
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Fiolet ATL, Silvis MJM, Opstal TSJ, Bax WA, van der Horst FAL, Mosterd A, de Kleijn D, Cornel JH. Short-term effect of low-dose colchicine on inflammatory biomarkers, lipids, blood count and renal function in chronic coronary artery disease and elevated high-sensitivity C-reactive protein. PLoS One 2020; 15:e0237665. [PMID: 32866166 PMCID: PMC7458326 DOI: 10.1371/journal.pone.0237665] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022] Open
Abstract
Aims Inflammation plays a pivotal role in atherothrombosis. Colchicine is an anti-inflammatory drug that may attenuate this process. Cardiovascular protective effects of anti-inflammatory drugs, however, seem to be limited to patients with a biochemical response. We therefore investigated whether short-term exposure to colchicine reduced inflammatory markers and whether additional laboratory changes occur in patients with chronic coronary artery disease. Methods & results In 138 consecutive patients with chronic coronary artery disease and a high sensitivity C-reactive Protein (hs-CRP) ≥ 2 mg/L, inflammatory markers, lipids, haematologic parameters and renal function were measured at baseline and after 30 days exposure to colchicine 0.5mg once daily. Hs-CRP decreased from baseline 4.40 mg/L (interquartile range [IQR] 2.83–6.99 mg/L) to 2.33 mg/L (IQR 1.41–4.17, median of the differences -1.66 mg/L, 95% confidence interval [CI] -2.17 – -1.22 mg/L, p-value <0.01), corresponding to a median change from baseline of -40%. Interleukin-6 decreased from 2.51 ng/L (IQR 1.59–4.32 ng/L) to 2.22 ng/L (median of the differences -0.36 ng/L, 95%CI -0.70 – -0.01 ng/L, p-value 0.04), corresponding to a median change from baseline of -16%. No clinically relevant changes in lipid fractions were observed. Both leukocyte and thrombocyte count decreased (median change from baseline -7% and -4% respectively). Estimated glomerular filtration rate decreased with a mean change from baseline of -2%. Conclusion In patients with chronic coronary artery disease and elevated hs-CRP, one-month exposure to colchicine 0.5 mg once daily was associated with a reduction of inflammatory markers. A small effect was seen on white blood cell count and platelet count, as well as a small decrease in estimated glomerular filtration rate.
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Affiliation(s)
- Aernoud T. L. Fiolet
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Network for Cardiovascular Research, Utrecht, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Max J. M. Silvis
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Willem A. Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Arend Mosterd
- Dutch Network for Cardiovascular Research, Utrecht, The Netherlands
- Department of Cardiology, Meander Medisch Centrum, Amersfoort, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dominique de Kleijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H. Cornel
- Dutch Network for Cardiovascular Research, Utrecht, The Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
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12
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Opstal TSJ, Hoogeveen RM, Fiolet ATL, Silvis MJM, The SHK, Bax WA, de Kleijn DPV, Mosterd A, Stroes ESG, Cornel JH. Colchicine Attenuates Inflammation Beyond the Inflammasome in Chronic Coronary Artery Disease: A LoDoCo2 Proteomic Substudy. Circulation 2020; 142:1996-1998. [PMID: 32864998 DOI: 10.1161/circulationaha.120.050560] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tjerk S J Opstal
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands (T.S.J.O., J.H.C.).,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (T.S.J.O., J.H.C.)
| | - Renate M Hoogeveen
- Department of Vascular Medicine, Amsterdam University Medical Centers, the Netherlands (R.M.H., E.S.G.S.)
| | - Aernoud T L Fiolet
- Departments of Cardiology (A.T.L.F., M.J.M.S., D.P.V.d.K.), University Medical Center Utrecht, the Netherlands.,Dutch Network for Cardiovascular Research, Utrecht, the Netherlands (A.T.L.F., A.M., J.H.C.)
| | - Max J M Silvis
- Departments of Cardiology (A.T.L.F., M.J.M.S., D.P.V.d.K.), University Medical Center Utrecht, the Netherlands
| | - Salem H K The
- Department of Cardiology, Treant Medical Center, Emmen, the Netherlands (S.H.K.T.)
| | - Willem A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands (W.A.B.)
| | - Dominique P V de Kleijn
- Departments of Cardiology (A.T.L.F., M.J.M.S., D.P.V.d.K.), University Medical Center Utrecht, the Netherlands.,Vascular Surgery (D.P.V.d.K.), University Medical Center Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands (D.P.V.d.K.)
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care (A.M.), University Medical Center Utrecht, the Netherlands.,Dutch Network for Cardiovascular Research, Utrecht, the Netherlands (A.T.L.F., A.M., J.H.C.).,Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M.)
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, the Netherlands (R.M.H., E.S.G.S.)
| | - Jan H Cornel
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands (T.S.J.O., J.H.C.).,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (T.S.J.O., J.H.C.).,Dutch Network for Cardiovascular Research, Utrecht, the Netherlands (A.T.L.F., A.M., J.H.C.)
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13
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Sharif H, Akash MSH, Rehman K, Irshad K, Imran I. Pathophysiology of atherosclerosis: Association of risk factors and treatment strategies using plant-based bioactive compounds. J Food Biochem 2020; 44:e13449. [PMID: 32851658 DOI: 10.1111/jfbc.13449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
Under physiological conditions, endothelial cells act as protective barrier which prevents direct contact of blood with circulating factors via production of tissue plasminogen activator. Risk factors of metabolic disorders are responsible to induce endothelial dysfunction and may consequently lead to prognosis of atherosclerosis. This article summarizes the process of atherosclerosis which involves number of sequences including formation and interaction of AGE-RAGE, activation of polyol pathway, protein kinase C, and hexosamine-mediated pathway. All these mechanisms can lead to the development of oxidative stress which may further aggravate condition. Different pharmacological interventions are being used to treat atherosclerosis, however, these might be associated with mild to severe side effects. Therefore, plant-based bioactive compounds having potential to combat and prevent atherosclerosis in diabetic patients are attaining recent focus. By understanding process of development and mechanisms involved in atherosclerotic plaque formation, these bioactive compounds can be better option for future therapeutic interventions for atherosclerosis treatment. PRACTICAL APPLICATIONS: Atherosclerosis is one of major underlying disorders of cardiovascular diseases which occur through multiple mechanisms and is associated with metabolic disorders. Conventional therapeutic interventions are not only used to treat atherosclerosis, but are also commonly associated with mild to severe side effects. Therefore, nowadays, bioactive compounds having potential to combat and prevent atherosclerosis in diabetic patients are preferred. By understanding mechanisms involved in atherosclerotic plaque formation, bioactive compounds can be better understood for treatment of atherosclerosis. In this manuscript, we have focused on treatment strategies of atherosclerosis using bioactive compounds notably alkaloids and flavonoids having diverse pharmacological and therapeutic potentials with special focus on the mechanism of action of these bioactive compounds suitable for treatment of atherosclerosis. This manuscript will provide the scientific insights of bioactive compounds to researchers who are working in the area of drug discovery and development to control pathogenesis and development of atherosclerosis and its associated cardiometabolic disorders.
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Affiliation(s)
- Hina Sharif
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | | | - Kanwal Rehman
- Department of Pharmacy, University of Agriculture, Faisalabad, Pakistan
| | - Kanwal Irshad
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Imran Imran
- Department of Pharmacology, Bahauddin Zakariya University, Multan, Pakistan
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14
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Inhibiting NLRP3 Inflammasome Activity in Acute Myocardial Infarction: A Review of Pharmacologic Agents and Clinical Outcomes. J Cardiovasc Pharmacol 2020; 74:297-305. [PMID: 31356538 DOI: 10.1097/fjc.0000000000000701] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The NLRP3 inflammasome is an intracellular, multimeric protein complex that initiates a potent inflammatory response to danger signals. After acute myocardial infarction, NLRP3 inflammasome-dependent inflammation promotes adverse left ventricular remodeling and recurrent atherosclerotic events. Selective and nonselective inhibitors of the NLRP3 inflammasome or its downstream effectors (interleukin-1β and interleukin-18) may prevent adverse left ventricular remodeling and recurrent atherosclerotic events. In this review, we highlight strategies to inhibit NLRP3 inflammasome activity and their potential roles in the management of acute myocardial infarction.
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15
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Alekberova ZS, Nasonov EL. PROSPECTS FOR USING COLCHICINE IN MEDICINE: NEW EVIDENCE. RHEUMATOLOGY SCIENCE AND PRACTICE 2020. [DOI: 10.14412/1995-4484-2020-183-190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology;
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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Abstract
PURPOSE OF REVIEW Based on compelling data from animal and human studies, over the past few decades, the viewpoint of atherosclerosis as an exclusively lipid-driven disease, has been gradually replaced by the concept of a chronic low-grade inflammatory process of the arterial wall. This review presents a brief description on the role of inflammation in atherosclerosis, and examines selected anti-inflammatory interventions that have been tested in clinical trials designed to prevent adverse cardiovascular disease (CVD) events and excess CVD risk. RECENT FINDINGS The Canakinumab Anti-inflammatory Thrombosis Outcomes Study trial has provided convincing evidence that neutralization of the interleukin (IL)-1β inflammatory pathway by the selective antibody canakinumab reduces major CVD events and significantly lowers IL-1β, IL-6 and high-sensitivity C-reactive protein, without affecting low-density lipoprotein cholesterol levels. In contrast, in the latest Cardiovascular Inflammation Reduction Trial, low-dose methotrexate compared with placebo did not reduce CVD events, probably because there was no reduction in IL-1β, or in downstream inflammatory biomarker levels either. SUMMARY Notwithstanding the utilization of effective medical treatments including statins and proprotein convertase subtilisin/kexin type 9 inhibitors or precise revascularizations, the recurrence of CVD events remains unacceptably high. Canakinumab is, at present, the only anti-inflammatory agent that has been proven to reduce cardiovascular events in patients with elevated markers of inflammation without modifying cholesterol levels. Nevertheless, clinical application related to this new evidence and associated knowledge has not yet been implemented in daily practice.
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Grossenbacher F, Giodarno Orsini G, Cazaubon Y, Fouret P, Djerada Z, Mégarbane B. Myocardial infarction in relation to colchicine poisoning: A precipitating cause of refractory toxic cardiogenic shock. Therapie 2020; 76:51-53. [PMID: 31992453 DOI: 10.1016/j.therap.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 11/14/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Yoann Cazaubon
- Laboratory of pharmacology and toxicology, Reims university hospital, 51000 Reims, France
| | - Pierre Fouret
- Department of pathology, Pitié Salpétrière Hospital, 75651 Paris, France
| | - Zoubir Djerada
- Laboratory of pharmacology and toxicology, Reims university hospital, 51000 Reims, France
| | - Bruno Mégarbane
- Department of medical and toxicological critical care, Lariboisière hospital, Paris-Diderot University, INSERM UMRS-1144, 75010 Paris, France.
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18
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Nidorf SM, Fiolet ATL, Eikelboom JW, Schut A, Opstal TSJ, Bax WA, Budgeon CA, Tijssen JGP, Mosterd A, Cornel JH, Thompson PL. The effect of low-dose colchicine in patients with stable coronary artery disease: The LoDoCo2 trial rationale, design, and baseline characteristics. Am Heart J 2019; 218:46-56. [PMID: 31706144 DOI: 10.1016/j.ahj.2019.09.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
Because patients with stable coronary artery disease are at continued risk of major atherosclerotic events despite effective secondary prevention strategies, there is a need to continue to develop additional safe, effective and well-tolerated therapies for secondary prevention of cardiovascular disease. RATIONALE AND DESIGN: The LoDoCo (Low Dose Colchicine) pilot trial showed that the anti-inflammatory drug colchicine 0.5 mg once daily appears safe and effective for secondary prevention of cardiovascular disease. Colchicine's low cost and long-term safety suggest that if its efficacy can be confirmed in a rigorous trial, repurposing it for secondary prevention of cardiovascular disease would have the potential to impact the global burden of cardiovascular disease. LoDoCo2 is an investigator-initiated, international, multicentre, double-blind, event driven trial in which 5522 patients with stable coronary artery disease tolerant to colchicine during a 30-day run-in phase have been randomized to colchicine 0.5 mg daily or matching placebo on a background of optimal medical therapy. The study will have 90% power to detect a 30% reduction in the composite primary endpoint: cardiovascular death, myocardial infarction, ischemic stroke and ischemia-driven coronary revascularization. Adverse events potentially related to the use of colchicine will also be collected, including late gastrointestinal intolerance, neuropathy, myopathy, myositis, and neutropenia. CONCLUSION: The LoDoCo2 Trial will provide information on the efficacy and safety of low-dose colchicine for secondary prevention in patients with stable coronary artery disease.
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Affiliation(s)
- Stefan M Nidorf
- GenesisCare Western Australia, Perth, Australia; Heart Research Institute of Western Australia, Perth, Australia
| | - Aernoud T L Fiolet
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands; The Netherlands Heart Institute, Utrecht, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Astrid Schut
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands
| | - Tjerk S J Opstal
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Willem A Bax
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Charley A Budgeon
- Department of Cardiovascular Sciences, University of Leicester, and the NIHR Leicester Cardiovascular Biomedical Research Unit Glenfield Hospital, Leicester, United Kingdom; Centre for Applied Statistics, University of Western Australia, Perth, Australia
| | - Jan G P Tijssen
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arend Mosterd
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Jan H Cornel
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands; Department of Cardiology, Radboud University Medical Center, The Netherlands.
| | - Peter L Thompson
- Heart Research Institute of Western Australia, Perth, Australia; Sir Charles Gairdner Hospital, Perth, Australia
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19
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Shader RI. “Inflamma” and Other “Somes”. Clin Ther 2019; 41:2-5. [DOI: 10.1016/j.clinthera.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022]
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20
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Thompson PL. Colchicine in Cardiovascular Disease: Repurposing an Ancient Gout Drug. Clin Ther 2018; 41:8-10. [PMID: 30594311 DOI: 10.1016/j.clinthera.2018.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Peter L Thompson
- Heart Research Institute, Sir Charles Gairdner Hospital Medical School, University of Western Australia, Crawley, Western Australia, Australia; Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
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Nidorf SM, Thompson PL. Why Colchicine Should Be Considered for Secondary Prevention of Atherosclerosis: An Overview. Clin Ther 2018; 41:41-48. [PMID: 30591286 DOI: 10.1016/j.clinthera.2018.11.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Colchicine is a widely available, inexpensive drug with a range of antiinflammatory properties that may make it suitable for the secondary prevention of atherosclerosis. This review examines how past and contemporary approaches to antiinflammatory therapy for atherosclerosis have led to a better understanding of the nature of the disease and sets out the reasons why colchicine has the potential to become a cornerstone therapy in its management. METHODS We performed a literature search using PubMed, the Cochrane library, and clinical trial registries to identify completed and ongoing clinical studies on colchicine in coronary artery disease, and a PubMed search to identify publications on the mechanism of action of colchicine relevant to atherosclerosis. FINDINGS A large body of data confirms that inflammation plays a pivotal role in atherosclerosis. The translation of this extensive knowledge into improved clinical outcomes has until recently been elusive. Findings from statin trials support the possibility that targeting inflammation may be beneficial, but this evidence has been inconclusive. Direct inhibition of atherosclerotic inflammation is being explored in current clinical trials. Targeted inhibition of interleukin 1β with canakinumab provided the proof of principle that limiting inflammation can improve outcomes in atherosclerotic vascular disease, but long-term treatment with a monoclonal antibody is unlikely to have widespread uptake. Other approaches using agents with a wider set of targets are being explored. Findings from observational studies suggest that methotrexate may reduce cardiovascular risk in patients with rheumatoid arthritis, but CIRT (Cardiovascular Inflammation Reduction Trial) demonstrated that methotrexate provided no cardiovascular benefit in patients with atherosclerotic vascular disease. Recent demonstration that cholesterol crystals trigger the NLRP3 (nucleotide oligomerization domain-, leucine-rich repeat-, and pyrin domain-containing protein 3) inflammasome and the release of inflammatory cytokines that also drive uric acid crystal-induced inflammation indicates that the multiple actions of colchicine that make it effective in gout may be relevant to preventing inflammation and limiting inflammatory injury in atherosclerosis. The ongoing LoDoCo2 (Low Dose Colchicine2) and COLCOT (Colchicine Cardiovascular Outcomes Trial) trials and several other planned large-scale rigorous trials will determine the long-term tolerability and efficacy of low-dose colchicine for secondary prevention in patients with coronary disease. IMPLICATION Colchicine holds promise as an important, accessible drug that could be successfully repurposed for the secondary prevention of atherosclerotic cardiovascular disease should its tolerability and cardiovascular benefits be confirmed in ongoing clinical trials.
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Affiliation(s)
- Stefan Mark Nidorf
- GenesisCare, Perth, Western Australia, Australia; Heart Research Institute, Perth, Western Australia; Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia.
| | - Peter Lindsay Thompson
- GenesisCare, Perth, Western Australia, Australia; Heart Research Institute, Perth, Western Australia; Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia; Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, Western Australia, Australia
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