Cost-effectiveness of colchicine treatment on post-operative atrial fibrillation events in patients of major cardiac surgery

Low-Dose Colchicine for the Prevention of Cardiovascular Events After Acute Coronary Syndrome

Colchicine, an established anti-inflammatory drug, is examined for its potential in mitigating adverse cardiovascular events following acute coronary syndrome (ACS). ACS, primarily triggered by plaque rupture and subsequent thrombosis, is a critical cardiovascular condition. Colchicine's mechanism of action involves inhibiting microtubule activity, leading to immobilization of white blood cells and reducing inflammation. Clinical data from studies, including low-dose colchicine for secondary prevention of cardiovascular disease two and colchicine cardiovascular outcomes trial, support its efficacy in reducing major cardiovascular events post-ACS, though some studies report varying results. Colchicine can cause transient gastrointestinal side effects and is prescribed with caution in patients with certain medical conditions. The recent FDA approval of a low dose of colchicine reiterates its benefit in reducing cardiovascular risk. The cost-effectiveness of colchicine products (0.5 and 0.6 mg doses) are compared, suggesting the generic 0.6 mg dose of colchicine to be an alternative to branded forms of the drug.

Colchicine - new horizons for an ancient drug. Review based on the highest hierarchy of evidence

Colchicine is an old, inexpensive, and relatively safe anti-inflammatory drug traditionally used in gout and over the last 50 years in familial Mediterranean fever. A search of all high-hierarchy studies (randomized controlled trials [RCTs], systematic reviews and meta-analysis of RCTs) over the last 20 years revealed myriad other evidence-based applications. Colchicine seems efficacious in the treatment of acute pericarditis and prevention of recurrences and in the prevention of postcardiac injury syndrome and atrial fibrillation following cardiac surgery or percutaneous interventions. In patients already fully treated with statins and antiplatelet agents following acute coronary syndromes or stable coronary disease, adding low-dose colchicine achieved secondary prevention of major cardiovascular events (myocardial infarction, stroke, or cardiovascular death) with pooled risk reduction 0.75. Colchicine may also be useful in Behcet's syndrome and most recently, in improving outcomes of COVID-19 infection. Colchicine in the low doses used in most trials (≤ 1 mg/d) was generally safe and well-tolerated, excepting diarrhea (approximately 10%) which sometimes led to drug discontinuation. Further RCTs are required to confirm these results, and will likely lead to expanding indications for low-dose colchicine. Increasing numbers of patients will be treated with colchicine in the near future, with improved health outcomes, as long as basic caveats are heeded.

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.

The Use of Colchicine in Cardiovascular Diseases: A Systematic Review

The medicinal properties of colchicine have been recognized for centuries. Although previously used for gout and familial Mediterranean fever, its immune-modulating, anti-inflammatory, and antifibrotic effects are increasingly recognized as beneficial in the treatment of cardiovascular disorders. In this systematic review, we summarize the current evidence on colchicine's effectiveness in 1) pericarditis, 2) coronary artery disease, and 3) atrial fibrillation. We also discuss the safety, potential adverse effects, and common drug interactions that should be considered during use.

Inflammation May be the Future of Cardiovascular Risk Reduction: Does Colchicine have a Current Indication?

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.