1
|
Imazio M, Agrimi C, Cescon L, Panzolli G, Collini V, Sinagra G. Colchicine for the treatment of the spectrum of cardiovascular diseases: current evidence and ongoing perspectives. J Cardiovasc Med (Hagerstown) 2024; 25:653-663. [PMID: 38916229 PMCID: PMC11296275 DOI: 10.2459/jcm.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/25/2024] [Accepted: 05/12/2024] [Indexed: 06/26/2024]
Abstract
Colchicine is one of the oldest drugs in medicine. Traditionally used to treat and prevent gouty attacks, it has been introduced into cardiovascular medicine for the treatment and prevention of pericarditis, starting from the positive experience in the treatment and prevention of polyserositis in familial mediterranean fever. Colchicine is a lipophilic drug that enters the cells and is eliminated by glycoprotein P. As granulocytes are lacking in this protein, colchicine is able to concentrate in these cells, exerting a substantial anti-inflammatory action, even with low oral doses. As these cells may trigger acute cardiovascular events, colchicine has been shown to be efficacious and safe to prevent acute coronary syndromes and ischemic stroke with an efficacy comparable to more established treatments, such as antiplatelet agents and statins. On this basis, colchicine seems a promising, efficacious, well tolerated, and cheap option for the prevention of several cardiovascular events, and it may become an additional pillar in the pharmacologic treatment of cardiovascular diseases.
Collapse
Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine
| | - Cosimo Agrimi
- Cardiology Specialty School, University of Trieste, Trieste, Italy
| | - Laura Cescon
- Cardiology Specialty School, University of Trieste, Trieste, Italy
| | | | - Valentino Collini
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine
| | | |
Collapse
|
2
|
Ebstein E, Ottaviani S. Managing Gout in Patients with Metabolic Syndrome. Drugs Aging 2024:10.1007/s40266-024-01132-x. [PMID: 39060816 DOI: 10.1007/s40266-024-01132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/28/2024]
Abstract
Gout is characterized by monosodium urate (MSU) crystal deposition secondary to hyperuricemia. Gout is associated with metabolic syndrome (MetS) and its related comorbid conditions such as cardiovascular disease (CVD). Major advances have been made in the comprehension of the link between MetS and gout. Despite observational studies suggesting an association between MetS-related conditions and hyperuricemia, there is no proof of causality. Most studies using Mendelian randomization did not find hyperuricemia as a causal factor for MetS-related conditions. In contrast, these conditions were found associated with hyperuricemia, which suggests a reverse causality. Among patients with gout, this high CVD risk profile implies the need for systematic screening for MetS-related conditions. Most international guidelines recommend systematic screening for and care of CVD and related risk factors in patients with gout. Some anti-hypertensive agents, such as losartan and calcium channel blockers, are able to decrease serum urate (SU) levels. However, there are potential interactions between gout management therapies and the treatment of metabolic diseases. Some data suggest that anti-inflammatory drugs used for gout flare treatment, such as colchicine or canakinumab, might have benefits for CVD. Regarding the impact of urate-lowering therapies on CVD risk, recent studies found a similar CVD safety profile for allopurinol and febuxostat. Finally, sodium-glucose cotransporter-2 inhibitors are promising for gout because of their ability to decrease SU levels and risk of recurrent flares. In this review, we focus on the clinical challenge of managing MetS in patients with gout, particularly older patients with co-medications.
Collapse
Affiliation(s)
- Esther Ebstein
- Rheumatology Department, Université Paris Cité, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Sébastien Ottaviani
- Rheumatology Department, Université Paris Cité, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
| |
Collapse
|
3
|
Verghese D, Hamal S, Ghanem A, Kinninger A, Javier D, Ichikawa K, Benzing T, Krishnan S, Kianoush S, Hamidi H, Bagheri M, Abraham D, Deljavanghodrati M, Ghoto A, Aldana-Bitar J, Budoff M. Effect of colchicine on progression of known coronary atherosclerosis in patients with STable CoROnary artery disease CoMpared to placebo (EKSTROM) trial-rationale and design. Am Heart J 2024; 277:20-26. [PMID: 39029568 DOI: 10.1016/j.ahj.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/17/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Cardiovascular disease is the major cause of mortality in the United States. Despite lifestyle modification and traditional risk factor control residual inflammatory risk remains an untreated concern. Colchicine is an oral, medication that has been used for gout, mediterranean fever and pericarditis for decades. In recent trials, colchicine has been shown to reduce major adverse cardiovascular events, however the mechanism of benefit remains unclear. The objective of the randomized, double-blind, placebo controlled EKSTROM trial is to evaluate the effects of colchicine 0.5mg/day on atherosclerotic plaque. METHODS Eighty-four participants will be enrolled after obtaining informed consent and followed for 12 months. Eligible patients will be randomly assigned to colchicine 0.5mg/day or placebo in a 1:1 fashion as add-on to their standard of care. All participants will undergo coronary computed tomography angiography (CCTA) at baseline and at 12 months. RESULTS As of November 2023, the study is 100% enrolled with an expected end of study by the second quarter of 2024. The primary endpoint is change in low attenuation plaque volume as measured by CCTA. Secondary endpoints include change in volume of different plaque types (including total atheroma volume, noncalcified plaque volume, dense calcified plaque volume, remodeling index), change in inflammatory markers (IL-6, IL-1β, IL-18, hs-CRP), change in pericoronary adipose tissue attenuation, change in epicardial adipose tissue volume and attenuation and change in brachial flow mediated dilation. CONCLUSION EKSTROM is the first randomized study to assess the effects of colchicine on plaque progression, pericoronary and epicardial fat. EKSTROM will provide important information on the mechanistic effects of colchicine on the cardiovascular system. TRIAL REGISTRATION Registry: clinicaltrials.gov, Registration Number: NCT06342609 url: https://www. CLINICALTRIALS gov/study/NCT06342609?term=EKSTROM&rank=1.
Collapse
Affiliation(s)
- Dhiran Verghese
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California; Department of Medicine, Division of Cardiovascular Medicine, NCH Rooney Heart Institute, Naples, Florida.
| | - Sajad Hamal
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Ahmed Ghanem
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - April Kinninger
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Denise Javier
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Keshi Ichikawa
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Travis Benzing
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Srikanth Krishnan
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Sina Kianoush
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Hossein Hamidi
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Marziyeh Bagheri
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Divya Abraham
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Mina Deljavanghodrati
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Ayesha Ghoto
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Jairo Aldana-Bitar
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| | - Matthew Budoff
- Department of Medicine, Division of Cardiovascular Medicine, The Lundquist Institute, Harbor UCLA Medical Center, Torrance, California
| |
Collapse
|
4
|
Yousefzadeh M, Khosrobeigi A, Salehi A. Studying the efficacy of low-dose colchicine on clinical outcomes of patients with STEMI: a randomized controlled trial. Egypt Heart J 2024; 76:85. [PMID: 38969838 PMCID: PMC11229522 DOI: 10.1186/s43044-024-00515-0] [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: 02/21/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Numerous studies have underscored the essential role of inflammation across all stages of atherosclerosis. While various anti-inflammatory interventions have been implemented to mitigate inflammation-induced injuries, outcomes have been conflicting. Given the essential role of inflammation in these patients and limited data regarding the efficacy of low-dose Colchicine as an anti-inflammatory drug, we aimed to study the efficacy of low-dose Colchicine on clinical outcomes of patients with STEMI in Iran. RESULTS Participants presented with STEMI and qualified revascularization at Shahid Beheshti Hospital in Qom during 2022 and 2023 were included into the study. This study included 172 STEMI patients (114 males and 58 females) within the mean age of 58.93 ± 7.79. Results indicate that colchicine (2 mg for loading dose and 0.5 mg daily for 30 days) and placebo group were not significant differences in identical profiles regarding age and gender. Analyses revealed no significant differences in clinical outcome after the 40-day follow-up period. CONCLUSIONS This study revealed that the addition of colchicine did not yield a significant benefit in enhancing the outcomes of patients with STEMI. CLINICAL TRIAL REGISTRATION This study was prospectively registered on Iranian registry of clinical trials, with registration number (IRCT20231001059578N1).
Collapse
Affiliation(s)
- Mojtaba Yousefzadeh
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran
| | - Ali Khosrobeigi
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran.
| | - Ayoub Salehi
- Cardiology Research Department, Qom University of Medical Sciences, Qom, Iran
| |
Collapse
|
5
|
Alunno A, Carubbi F, Martini C, Moronti V, Santilli J, Schoones JW, Mariani FM, Di Ruscio E, Altieri P, Ferri C. A systematic literature review of randomised controlled trials evaluating colchicine for cardiovascular prevention: There is an elephant in the room. Eur J Intern Med 2024; 125:44-50. [PMID: 38171935 DOI: 10.1016/j.ejim.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To review randomised controlled trials (RCT) investigating colchicine (COL) for cardiovascular (CV) prevention in patients at high to very high CV risk aiming to extract data that could be useful in rheumatology practice. METHODS A systematic search of multiple databases according to the PICO framework was performed from inception to April 3, 2023. Three researchers independently screened abstracts/titles and reviewed full texts reviewed. Data extraction was performed using a pilot-tested data extraction form. RESULTS A total of 14,096 references were retrieved by the search and 30 articles, describing 28 RCTs, were included in the review (Total number of patients 16,795, of which 8,463 randomised to COL; dose 0.5-2 mg/day, treatment duration 1day-29 months). Only one of the 28 RCTs provided clear information on whether patients with rheumatic diseases (more specifically gout) were enrolled in the study cohorts and previous use of COL was an exclusion criterion only in 14 (50 %) RCTs. Previous therapy with glucocorticoids and/or non-steroidal anti-inflammatory drugs and/or immune suppressive therapies was an exclusion criterion only in 9 (32 %) RCTs. CONCLUSION Our results highlight the need to redefine the eligibility criteria as well as the reporting of results in future RCTs in order to minimise bias or previous exposure to COL and also obtain data that could be useful in rheumatology practice.
Collapse
Affiliation(s)
- Alessia Alunno
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy.
| | - Francesco Carubbi
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Cecilia Martini
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Veronica Moronti
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Jessica Santilli
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesco Maria Mariani
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Evy Di Ruscio
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Piera Altieri
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| |
Collapse
|
6
|
Tripathi S, Rani K, Raj VS, Ambasta RK. Drug repurposing: A multi targetted approach to treat cardiac disease from existing classical drugs to modern drug discovery. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2024; 207:151-192. [PMID: 38942536 DOI: 10.1016/bs.pmbts.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Cardiovascular diseases (CVDs) are characterized by abnormalities in the heart, blood vessels, and blood flow. CVDs comprise a diverse set of health issues. There are several types of CVDs like stroke, endothelial dysfunction, thrombosis, atherosclerosis, plaque instability and heart failure. Identification of a new drug for heart disease takes longer duration and its safety efficacy test takes even longer duration of research and approval. This chapter explores drug repurposing, nano-therapy, and plant-based treatments for managing CVDs from existing drugs which saves time and safety issues with testing new drugs. Existing drugs like statins, ACE inhibitor, warfarin, beta blockers, aspirin and metformin have been found to be useful in treating cardiac disease. For better drug delivery, nano therapy is opening new avenues for cardiac research by targeting interleukin (IL), TNF and other proteins by proteome interactome analysis. Nanoparticles enable precise delivery to atherosclerotic plaques, inflammation areas, and damaged cardiac tissues. Advancements in nano therapeutic agents, such as drug-eluting stents and drug-loaded nanoparticles are transforming CVDs management. Plant-based treatments, containing phytochemicals from Botanical sources, have potential cardiovascular benefits. These phytochemicals can mitigate risk factors associated with CVDs. The integration of these strategies opens new avenues for personalized, effective, and minimally invasive cardiovascular care. Altogether, traditional drugs, phytochemicals along with nanoparticles can revolutionize the future cardiac health care by identifying their signaling pathway, mechanism and interactome analysis.
Collapse
Affiliation(s)
- Shyam Tripathi
- Centre for Drug Design Discovery and Development (C4D), Department of Biotechnology and Microbiology, SRM University, Delhi-NCR, Rajiv Gandhi Education City, Sonepat, Haryana, India
| | - Kusum Rani
- Centre for Drug Design Discovery and Development (C4D), Department of Biotechnology and Microbiology, SRM University, Delhi-NCR, Rajiv Gandhi Education City, Sonepat, Haryana, India
| | - V Samuel Raj
- Centre for Drug Design Discovery and Development (C4D), Department of Biotechnology and Microbiology, SRM University, Delhi-NCR, Rajiv Gandhi Education City, Sonepat, Haryana, India.
| | - Rashmi K Ambasta
- Centre for Drug Design Discovery and Development (C4D), Department of Biotechnology and Microbiology, SRM University, Delhi-NCR, Rajiv Gandhi Education City, Sonepat, Haryana, India.
| |
Collapse
|
7
|
Zhang RS, Weber BN, Araiza-Garaygordobil D, Garshick MS. Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation. Curr Cardiol Rep 2024; 26:423-434. [PMID: 38573553 PMCID: PMC11196186 DOI: 10.1007/s11886-024-02049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Targeting traditional cardiovascular risk factors is effective in reducing recurrent cardiovascular events, yet the presence of residual cardiovascular risk due to underlying systemic inflammation is a largely unaddressed opportunity. This review aims to comprehensively assess the evolving role of colchicine as a therapeutic approach targeting residual inflammatory risk in the context of those with coronary artery disease (CAD). RECENT FINDINGS Inflammation plays a significant role in promoting atherosclerosis, and targeting anti-inflammatory pathways has the potential to decrease cardiovascular events. Low-dose colchicine (0.5 mg/day orally), when added to guideline-directed medical care for CAD, safely decreases major adverse cardiovascular events (MACE) by 31% in stable atherosclerosis patients and 23% in those after recent myocardial infarctions. Meta-analyses of recent randomized control trials further support both the efficacy and safety of colchicine, particularly when added to other standard cardiovascular therapies, including statin therapy. The European Society of Cardiology and other national guidelines endorse the use of low-dose colchicine in patients across the spectrum of CAD. Recently, colchicine was FDA-approved in the United States as the first anti-inflammatory therapy for the reduction of cardiovascular events. In a period of a rising incidence of CAD across the globe, colchicine represents a unique opportunity to decrease MACE due to its large magnitude of benefits and general affordability. However, challenges with drug interactions must be addressed, especially in those regions where HIV, hepatitis, and tuberculosis are prevalent. Colchicine is safe and effective at reducing cardiovascular events across a broad spectrum of coronary syndromes. The ability to simultaneously target traditional risk factors and mitigate residual inflammatory risk marks a substantial advancement in cardiovascular prevention strategies, heralding a new era in the global battle against CAD.
Collapse
Affiliation(s)
- Robert S Zhang
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Brittany N Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michael S Garshick
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA.
| |
Collapse
|
8
|
Banco D, Mustehsan M, Shah B. Update on the Role of Colchicine in Cardiovascular Disease. Curr Cardiol Rep 2024; 26:191-198. [PMID: 38340273 DOI: 10.1007/s11886-024-02026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW This review focuses on the use of colchicine to target inflammation to prevent cardiovascular events among those at-risk for or with established coronary artery disease. RECENT FINDINGS Colchicine is an anti-inflammatory drug that reduces cardiovascular events through its effect on the IL-1β/IL-6/CRP pathway, which promotes the progression and rupture of atherosclerotic plaques. Clinical trials have demonstrated that colchicine reduces cardiovascular events by 31% among those with chronic coronary disease, and by 23% among those with recent myocardial infarction. Its ability to dampen inflammation during an acute injury may broaden its scope of use in patients at risk for cardiovascular events after major non-cardiac surgery. Colchicine is an effective anti-inflammatory therapy in the prevention of acute coronary syndrome. Ongoing studies aim to assess when, and in whom, colchicine is most effective to prevent cardiovascular events in patients at-risk for or with established coronary artery disease.
Collapse
Affiliation(s)
- Darcy Banco
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Mohammad Mustehsan
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Binita Shah
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, 10016, USA.
- VA New York Harbor Healthcare System, 423 E 23rd Street, Office 12023-W, New York, NY, 10010, USA.
| |
Collapse
|
9
|
Akl E, Sahami N, Labos C, Genest J, Zgheib A, Piazza N, Jolly S. Meta-Analysis of Randomized Trials: Efficacy and Safety of Colchicine for Secondary Prevention of Cardiovascular Disease. J Interv Cardiol 2024; 2024:8646351. [PMID: 38505729 PMCID: PMC10950412 DOI: 10.1155/2024/8646351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/28/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Background Colchicine has shown potential cardioprotective effects owing to its broad anti-inflammatory properties. We performed a meta-analysis to assess its safety and efficacy in secondary prevention in patients with established coronary artery disease (CAD). Methods We searched Ovid Healthstar, MEDLINE, and Embase (inception to May 2022) for randomized controlled trials (RCTs) evaluating the cardiovascular effects of colchicine compared with placebo or usual care in patients with CAD. Study-level data on efficacy and safety outcomes were pooled using the Peto method. The primary outcome was the composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke. Results A total of 8 RCTs were included with a follow-up duration of ≥1 month, comprising a total of 12,151 patients. Compared with placebo or usual care, colchicine was associated with a significant risk reduction in the primary outcome (odds ratio (OR) 0.70, 95% CI 0.60 to 0.83, P < 0.0001; I2 = 52%). Risks of MI (OR 0.75, 95% CI 0.62 to 0.91, P = 0.003; I2 = 33%), stroke (OR 0.47, 95% CI 0.30 to 0.74, P = 0.001; I2 = 0%), and unplanned coronary revascularization (OR 0.67, 95% CI 0.55 to 0.82, P = 0.0001; I2 = 58%) were all reduced in the colchicine group. Rates of CV and all-cause mortality did not differ between the two groups, but there was an increase in noncardiac deaths with colchicine (OR 1.54, 95% CI 1.10 to 2.15, P = 0.01; I2 = 51%). The occurrence of all other adverse events was similar between the two groups, including GI reactions (OR 1.06, 95% CI 0.94 to 1.20, P = 0.35; I2 = 42%) and infections (OR 1.04, 95% CI 0.84 to 1.28, P = 0.74; I2 = 53%). Conclusions Colchicine therapy may reduce the risk of future cardiovascular events in patients with established CAD; however, there remains a concern about non-CV mortality. Further trials are underway that will shed light on non-CV mortality and colchicine NCT03048825, and NCT02898610.
Collapse
Affiliation(s)
- Elie Akl
- McGill University, Montreal, Canada
| | | | | | | | | | | | | |
Collapse
|
10
|
Roddy E, Bajpai R, Forrester H, Partington RJ, Mallen CD, Clarson LE, Padmanabhan N, Whittle R, Muller S. Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink. Ann Rheum Dis 2023; 82:1618-1625. [PMID: 37788904 PMCID: PMC10646835 DOI: 10.1136/ard-2023-224154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/10/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To determine the risk of adverse events associated with colchicine or non-steroidal anti-inflammatory drug (NSAID) prophylaxis when initiating allopurinol for gout. METHODS We conducted two matched retrospective cohort studies in linked UK Clinical Practice Research Datalink and Hospital Episode Statistics datasets. Adults initiating allopurinol for gout with (1) colchicine or (2) NSAID prophylaxis were compared with those initiating without prophylaxis, individually matched by age, sex and propensity to receive the relevant prophylaxis. Weighted Cox proportional hazards models investigated associations between colchicine/NSAID and specified adverse events. RESULTS 13 945 individuals prescribed colchicine were matched to 13 945 with no prophylaxis and 25 980 prescribed NSAID to 25 980 with no prophylaxis. Adverse event incidence rates were <200/10 000 patient-years except diarrhoea (784.4; 95% CI 694.0 to 886.5) and nausea (208.1; 95% CI 165.4 to 261.7) for colchicine and angina for NSAID (466.6; 95% CI 417.2 to 521.8). Diarrhoea (HR 2.22; 95% CI 1.83 to 2.69), myocardial infarction (MI) (1.55; 95% CI 1.10, 2.17), neuropathy (4.75; 95% CI 1.20 to 18.76), myalgia (2.64; 95% CI 1.45 to 4.81), bone marrow suppression (3.29; 95% CI 1.43 to 7.58) and any adverse event (1.91, 95% CI 1.65 to 2.20) were more common with colchicine than no prophylaxis, but not nausea/vomiting (1.34; 95% CI 0.97 to 1.85). Angina (1.60; 95% CI 1.37 to 1.86), acute kidney injury (1.56; 95% CI 1.20 to 2.03), MI (1.89; 95% CI 1.44 to 2.48), peptic ulcer disease (1.67; 95% CI 1.14 to 2.44) and any adverse event (1.63; 95% CI 1.44 to 1.85) were more common with NSAID than without. CONCLUSIONS Adverse events were more common when allopurinol was initiated with prophylaxis, particularly diarrhoea with colchicine. Other events were uncommon, providing reassurance for patients and clinicians to enable shared decision-making.
Collapse
Affiliation(s)
- Edward Roddy
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-on-Trent, UK
| | - Ram Bajpai
- School of Medicine, Keele University, Keele, UK
| | | | | | | | | | | | | | - Sara Muller
- School of Medicine, Keele University, Keele, UK
| |
Collapse
|
11
|
Nidorf SM. Seeing Colchicine in a New Light: Repurposing Low-dose Colchicine for Secondary Prevention of Cardiovascular Disease. Clin Ther 2023; 45:1029-1033. [PMID: 37516564 DOI: 10.1016/j.clinthera.2023.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE This review presents a modern perspective on the cardiovascular re-purposing of colchicine, the oldest drug in the pharmacopeia other than aspirin that is still in regular use. METHODS This article presents a brief overview of colchicine's long history as a medicine, as well as a critical review of safety and efficacy from the results of recent cardiovascular clinical trials. FINDINGS Long-term continuous colchicine use at doses between 0.6 and 2.4 mg has been used to prevent inflammatory flares in patients with gout and familial Mediterranean fever and less commonly employed in a range of other inflammatory conditions. In these settings, lifelong therapy has been found to be safe and well tolerated. Understanding the central role of inflammation in atherosclerosis has led to the search for effective anti-inflammatory agents that can be used continuously in combination with a range of other medications, including lipid-lowering therapies, antiplatelet therapy, and anticoagulants. The results of recent robust randomized clinical trials of low-dose colchicine (0.5 mg daily) in patients with coronary disease recently led the US Food and Drug Administration to approve its use as a new cornerstone therapy for secondary prevention in patients with coronary disease. Several misconceptions regarding the safety and tolerability of low dose colchicine are addressed. IMPLICATIONS Colchicine has emerged from its traditional role in medicine as the prevention of gout flare as the first anti-inflammatory agent to be approved by the US Food and Drug Administration for the secondary prevention of atherosclerosis.
Collapse
Affiliation(s)
- Stefan Mark Nidorf
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, QEII Campus, Nedlands, Western Australia.
| |
Collapse
|
12
|
Nelson K, Fuster V, Ridker PM. Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:648-660. [PMID: 37558377 DOI: 10.1016/j.jacc.2023.05.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 08/11/2023]
Abstract
Among statin-treated patients, inflammation assessed by means of high-sensitivity C-reactive protein (hsCRP) is a more powerful determinant of cardiovascular death and all-cause mortality than low-density-lipoprotein cholesterol (LDL-C). Several therapies that target residual inflammatory risk significantly reduce vascular event rates. For coronary artery disease patients already taking guideline-directed medical care, including statins, low-dose colchicine (0.5 mg/d orally) has been shown to safely lower major adverse cardiovascular events by 31% among those with stable atherosclerosis and by 23% after recent myocardial infarction. These magnitudes of benefit are larger than those seen in contemporary secondary prevention trials of adjunctive lipid-lowering agents. Low-dose colchicine is contraindicated in patients with significant renal or liver dysfunction and should be temporarily discontinued when taking concomitant agents such as clarithromycin, ketoconazole, and cyclosporine that share metabolism pathways. Lipid lowering and inflammation inhibition are not in conflict but are synergistic. In the future, combined use of aggressive LDL-C-lowering and inflammation-inhibiting therapies may become standard of care for most atherosclerosis patients. In June 2023, the U.S. Food and Drug Administration approved the use of low-dose colchicine to reduce the risk of myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.
Collapse
Affiliation(s)
- Kyle Nelson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
13
|
Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2023; 45:101191. [PMID: 36923949 PMCID: PMC10009207 DOI: 10.1016/j.ijcha.2023.101191] [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: 11/21/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
Background Colchicine has anti-inflammatory properties, but its utility in improving cardiovascular outcomes has been disputed. Here, we study the impact of colchicine on cardiovascular outcomes in patients with gout with and without coronary artery disease (CAD). Methods Medline, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary outcomes included myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Secondary outcomes included stroke and all-cause mortality. Results We included 4 observational studies comprising 10,026 patients with gout on treatment with colchicine. There was no significant difference in the risk of myocardial infarction (risk ratio [RR] 0.71; 95% confidence interval [CI], 0.36-1.39), need for PCI, or need for CABG, between patients on colchicine and those not receiving colchicine. Colchicine was associated with a significantly lower risk of all-cause mortality (RR 0.58; 95% CI 0.43-0.79). Conclusion Non-randomized studies suggest that risk of MI, stroke and revascularization is not higher in gout patients treated with colchicine compared to gout patients without colchicine treatment.
Collapse
|
14
|
Abstract
Vascular age is determined by functional and structural changes in the arterial wall. When measured by its proxy, pulse wave velocity, it has been shown to predict cardiovascular and total mortality. Disconcordance between chronological and vascular age might represent better or worse vascular health. Cell senescence is caused by oxidative stress and sustained cell replication. Senescent cells acquire senescence-associated secretory phenotype. Oxidative stress, endothelial dysfunction, dysregulation of coagulation and leucocyte infiltration are observed in the aging endothelium. All of these mechanisms lead to increased vascular calcification and stiffness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can involve the vascular endothelium. It enters cells using angiotensin-converting enzyme 2 (ACE-2) receptors, which are abundant in endothelial cells. The damage this virus does to the endothelium can be direct or indirect. Indirect damage is caused by hyperinflammation. Direct damage results from effects on ACE-2 receptors. The reduction of ACE-2 levels seen during coronavirus disease 2019 (COVID-19) infection might cause vasoconstriction and oxidative stress. COVID-19 and vascular aging share some pathways. Due to the novelty of the virus, there is an urgent need for studies that investigate its long-term effects on vascular health.
Collapse
Affiliation(s)
- Ignas Badaras
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania,Ignas Badaras, Faculty of Medicine, Vilnius
University, M. K. Ciurlionio g. 21/27, LT-03101, Vilnius 01513, Lithuania.
| | - Agnė Laučytė-Cibulskienė
- Department of Nephrology, Skåne University
Hospital, Malmö, Sweden,Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
15
|
Cimmino G, Loffredo FS, De Rosa G, Cirillo P. Colchicine in Athero-Thrombosis: Molecular Mechanisms and Clinical Evidence. Int J Mol Sci 2023; 24:ijms24032483. [PMID: 36768804 PMCID: PMC9917272 DOI: 10.3390/ijms24032483] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Several lines of evidence have clearly indicated that inflammation plays a pivotal role in the development of atherosclerosis and of its thrombotic complications such as acute coronary syndromes or ischemic stroke. Thus, it has been postulated that the use of anti-inflammatory agents might be extremely useful to improve cardiovascular outcome. Recently, increasing attention has been reserved to one of the oldest plant-derived drugs still in use in clinical practice, colchicine that has been used as drug to treat inflammatory diseases such gout or Mediterranean fever. To date, current guidelines of the European Society of Cardiology have included colchicine as first line choice for treatment of acute and recurrent pericarditis. Moreover, several studies have investigated its role in the clinical scenarios of cardiovascular disease including chronic and acute coronary syndromes with promising results. In this review, starting from a description of the mechanism(s) involved behind its anti-inflammatory effects, we give an overview on its potential effects in atherothrombosis and finally present an updated overview of clinical evidence on the role of this drug in cardiovascular disease.
Collapse
Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7064239
| | - Francesco S. Loffredo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy
| |
Collapse
|
16
|
Rakocevic J, Dobric M, Borovic ML, Milutinovic K, Milenkovic S, Tomasevic M. Anti-Inflammatory Therapy in Coronary Artery Disease: Where Do We Stand? Rev Cardiovasc Med 2023; 24:10. [PMID: 39076864 PMCID: PMC11270465 DOI: 10.31083/j.rcm2401010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 07/31/2024] Open
Abstract
Inflammation plays an important role in all stages of atherosclerosis - from endothelial dysfunction, to formation of fatty streaks and atherosclerotic plaque, and its progression to serious complications, such as atherosclerotic plaque rupture. Although dyslipidemia is a key driver of atherosclerosis, pathogenesis of atherosclerosis is now considered interplay between cholesterol and inflammation, with the significant role of the immune system and immune cells. Despite modern therapeutic approaches in primary and secondary cardiovascular prevention, cardiovascular diseases remain the leading cause of mortality worldwide. In order to reduce residual cardiovascular risk, despite the guidelines-guided optimal medical therapy, novel therapeutic strategies are needed for prevention and management of coronary artery disease. One of the innovative and promising approaches in atherosclerotic cardiovascular disease might be inflammation-targeted therapy. Numerous experimental and clinical studies are seeking into metabolic pathways underlying atherosclerosis, in order to find the most suitable pathway and inflammatory marker/s that should be the target for anti-inflammatory therapy. Many anti-inflammatory drugs have been tested, from the well-known broad range anti-inflammatory agents, such as colchicine, allopurinol and methotrexate, to targeted monoclonal antibodies specifically inhibiting a molecule included in inflammatory pathway, such as canakinumab and tocilizumab. To date, there are no approved anti-inflammatory agents specifically indicated for silencing inflammation in patients with coronary artery disease. The most promising results came from the studies which tested colchicine, and studies where the inflammatory-target was NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome/interleukin-1 beta (IL-1 β )/interleukin-6 (IL-6)/C-reactive protein (CRP) pathway. A growing body of evidence, along with the ongoing clinical studies, suggest that the anti-inflammatory therapy might become an additional strategy in treating atherosclerotic cardiovascular disease. Herein we present an overview of the role of inflammation in atherosclerosis, the most important inflammatory markers chosen as targets of anti-inflammatory therapy, along with the critical review of the major clinical trials which tested non-targeted and targeted anti-inflammatory drugs in patients with atherosclerotic cardiovascular disease.
Collapse
Affiliation(s)
- Jelena Rakocevic
- Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Dobric
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milica Labudovic Borovic
- Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Katarina Milutinovic
- Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Miloje Tomasevic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| |
Collapse
|
17
|
Singh D, Rai V, Agrawal DK. Non-Coding RNAs in Regulating Plaque Progression and Remodeling of Extracellular Matrix in Atherosclerosis. Int J Mol Sci 2022; 23:13731. [PMID: 36430208 PMCID: PMC9692922 DOI: 10.3390/ijms232213731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Non-coding RNAs (ncRNAs) regulate cell proliferation, migration, differentiation, inflammation, metabolism of clinically important biomolecules, and other cellular processes. They do not encode proteins but are involved in the regulatory network of various proteins that are directly related to the pathogenesis of diseases. Little is known about the ncRNA-associated mechanisms of atherosclerosis and related cardiovascular disorders. Remodeling of the extracellular matrix (ECM) is critical in the pathogenesis of atherosclerosis and related disorders; however, its regulatory proteins are the potential subjects to explore with special emphasis on epigenetic regulatory components. The activity of regulatory proteins involved in ECM remodeling is regulated by various ncRNA molecules, as evident from recent research. Thus, it is important to critically evaluate the existing literature to enhance the understanding of nc-RNAs-regulated molecular mechanisms regulating ECM components, remodeling, and progression of atherosclerosis. This is crucial since deregulated ECM remodeling contributes to atherosclerosis. Thus, an in-depth understanding of ncRNA-associated ECM remodeling may identify novel targets for the treatment of atherosclerosis and other cardiovascular diseases.
Collapse
Affiliation(s)
| | | | - Devendra K. Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| |
Collapse
|
18
|
Shi X, Jiang X, Chen C, Zhang Y, Sun X. The interconnections between the microtubules and mitochondrial networks in cardiocerebrovascular diseases: Implications for therapy. Pharmacol Res 2022; 184:106452. [PMID: 36116706 DOI: 10.1016/j.phrs.2022.106452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
Microtubules, a highly dynamic cytoskeleton, participate in many cellular activities including mechanical support, organelles interactions, and intracellular trafficking. Microtubule organization can be regulated by modification of tubulin subunits, microtubule-associated proteins (MAPs) or agents modulating microtubule assembly. Increasing studies demonstrate that microtubule disorganization correlates with various cardiocerebrovascular diseases including heart failure and ischemic stroke. Microtubules also mediate intracellular transport as well as intercellular transfer of mitochondria, a power house in cells which produce ATP for various physiological activities such as cardiac mechanical function. It is known to all that both microtubules and mitochondria participate in the progression of cancer and Parkinson's disease. However, the interconnections between the microtubules and mitochondrial networks in cardiocerebrovascular diseases remain unclear. In this paper, we will focus on the roles of microtubules in cardiocerebrovascular diseases, and discuss the interplay of mitochondria and microtubules in disease development and treatment. Elucidation of these issues might provide significant diagnostic value as well as potential targets for cardiocerebrovascular diseases.
Collapse
Affiliation(s)
- Xingjuan Shi
- School of Life Science and Technology, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, China.
| | - Xuan Jiang
- School of Life Science and Technology, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, China
| | - Congwei Chen
- School of Life Science and Technology, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, China
| | - Yu Zhang
- School of Life Science and Technology, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, China
| | - Xiaoou Sun
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, China.
| |
Collapse
|
19
|
Colchicine linked with risk reduction for myocardial infarction in gout patients: systematic review and meta-analysis. Z Rheumatol 2022; 81:501-506. [PMID: 35794279 DOI: 10.1007/s00393-022-01232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION This meta-analysis aimed to identify the effect of colchicine on myocardial infarction (MI) in patients with gout. METHODS In February 2021, a systematic computer-based search was conducted in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Data on patients with gout that compared colchicine versus others (no use of colchicine) were retrieved. The endpoints were the incidence rate for MI. After testing for heterogeneity between studies, data were aggregated for fixed-effects models when necessary. RESULTS Three clinical studies with 3012 patients (colchicine group = 1523, control group = 1489) were finally included in the meta-analysis. Colchicine was associated with a decreased risk for myocardial infarction (pooled odds ratio 0.35, 95% confidence interval 0.23-0.55, p < 0.00001). CONCLUSIONS Colchicine was effective in reducing the incidence of MI in patients with gout.
Collapse
|
20
|
Chen T, Liu G, Yu B. Colchicine for Coronary Artery Disease: A Review. Front Cardiovasc Med 2022; 9:892588. [PMID: 35783861 PMCID: PMC9246049 DOI: 10.3389/fcvm.2022.892588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary artery disease is a serious threat to human health. More and more evidences indicate chronic inflammatory plays a key role in the development of this disease. Inflammation markers are gradually used in the diagnosis and treatment. Although the treatment of coronary heart disease with colchicine is still controversial, more and more studies showed that patients can benefit from this medicine. In this review, we discuss and summarize colchicine on essential pharmacology, anti-inflammatory mechanism of action, and the most important and recent clinical studies. According to these literatures, colchicine possibly will possibly become a new valuable and cheap medicine for the treatment of coronary artery disease.
Collapse
Affiliation(s)
- Tao Chen
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guihong Liu
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Yu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Bo Yu,
| |
Collapse
|
21
|
Abstract
Drug repurposing is the use of a given therapeutic agent for indications other than that for which it was originally designed or intended. The concept is appealing because of potentially lower development costs and shorter timelines than are needed to produce a new drug. To date, drug repurposing for cardiovascular indications has been opportunistic and driven by knowledge of disease mechanisms or serendipitous observation rather than by systematic endeavours to match an existing drug to a new indication. Innovations in two areas of personalized medicine — computational approaches to associate drug effects with disease signatures and predictive model systems to screen drugs for disease-modifying activities — support efforts that together create an efficient pipeline to systematically repurpose drugs to treat cardiovascular disease. Furthermore, new experimental strategies that guide the medicinal chemistry re-engineering of drugs could improve repurposing efforts by tailoring a medicine to its new indication. In this Review, we summarize the historical approach to repurposing and discuss the technological advances that have created a new landscape of opportunities. Drugs can be repurposed for new therapeutic indications. In this Review, Mercola and colleagues summarize the latest techniques for systematic drug repurposing and re-engineering, which could increase the pace, efficiency and cost-effectiveness of drug discovery for the treatment of cardiovascular disease. Contemporary technologies are expected to make drug repurposing large-scale, systematic and deliberate rather than opportunistic. New experimental and computational tools harness patient genomics for drug repurposing. Discovery of repurposed drugs on the basis of patient genomics has implications for precision prescribing of medicines to treat individual patients. The treatment of rare, monogenic diseases, which often provide too little return on investment to incentivize conventional drug discovery, might benefit because the molecular aetiologies of these diseases are well suited to the discovery of drug repurposing candidates.
Collapse
|
22
|
Roth ME, Chinn ME, Dunn SP, Bilchick KC, Mazimba S. Association of colchicine use for acute gout with clinical outcomes in acute decompensated heart failure. Clin Cardiol 2022; 45:733-741. [PMID: 35481608 PMCID: PMC9286335 DOI: 10.1002/clc.23830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background Gout is a common comorbidity in heart failure (HF) patients and is frequently associated with acute exacerbations during treatment for decompensated HF. Although colchicine is often used to manage acute gout in HF patients, its impact on clinical outcomes when used during acute decompensated HF is unknown. Methods This was a single center, retrospective study of hospitalized patients treated for an acute HF exacerbation with and without acute gout flare between March 2011 and December 2020. We assessed clinical outcomes in patients treated with colchicine for a gout flare compared to those who did not experience a gout flare or receive colchicine. The primary outcome was in‐hospital all‐cause mortality. Results Among 1047 patient encounters for acute HF during the study period, there were 237 encounters (22.7%) where the patient also received colchicine for acute gout during admission. In‐hospital all‐cause mortality was significantly reduced in the colchicine group compared with the control group (2.1% vs. 6.5%, p = .009). The colchicine group had increased length of stay (9.93 vs. 7.96 days, p < .001) but no significant difference in 30‐day readmissions (21.5% vs. 19.5%, p = .495). In a Cox proportional hazards model adjusted for age, inpatient colchicine use was associated with improved survival to discharge (hazards ratio [HR] 0.163, 95% confidence interval [CI] 0.051−0.525, p = .002) and a reduced rate of in‐hospital CV mortality (HR 0.184, 95% CI 0.044−0.770, p = .021). Conclusion Among patients with a HF exacerbation, treatment with colchicine for a gout flare was associated with significantly lower in‐hospital mortality compared with those not treated for acute gout.
Collapse
Affiliation(s)
- Mary E Roth
- Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA
| | - Melissa E Chinn
- Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA
| | - Steven P Dunn
- Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA
| | - Kenneth C Bilchick
- Department of Medicine-Cardiovascular Medicine, University of Virginia Health, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Department of Medicine-Cardiovascular Medicine, University of Virginia Health, Charlottesville, Virginia, USA
| |
Collapse
|
23
|
Effect of Treatment with Colchicine after Acute Coronary Syndrome on Major Cardiovascular Events: A Systematic Review and Meta-Analysis of Clinical Trials. Cardiovasc Ther 2022; 2022:8317011. [PMID: 35495414 PMCID: PMC9020977 DOI: 10.1155/2022/8317011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Aim Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow-up or death, myocardial infarction (MI), and stroke with at least 30-day follow-up as outcomes were included. Results Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and noncolchicine groups. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low-dose consumption can avoid GI side effects of colchicine. Conclusion Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting; it would be worthy that future large-scale well-designed clinical trials address this issue by resolving the limitations of previous investigations.
Collapse
|
24
|
Niu Y, Bai N, Ma Y, Zhong PY, Shang YS, Wang ZL. Safety and efficacy of anti-inflammatory therapy in patients with coronary artery disease: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:84. [PMID: 35246052 PMCID: PMC8896203 DOI: 10.1186/s12872-022-02525-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The inflammation hypothesis of atherosclerosis has been put forward for more than 20 years. Although many animal experiments have suggested that anti-inflammatory therapy can inhibit the atherosclerotic process, the efficacy of anti-inflammatory therapy for patients with coronary artery disease (CAD) is still controversial. Therefore, this study aims to evaluate the safety and efficacy of anti-inflammatory drugs in patients with CAD. Method We conducted this systematic review and meta-analysis of randomized controlled trials by searching PubMed, EMBASE, web of science, and Cochrane Library database. The primary outcome was a composite outcome of cardiovascular death, myocardial infarction (MI), or stroke. The secondary outcomes included individual MI, coronary revascularization, cardiovascular death, all-cause death, and stroke. The relative risk (RR) and 95% confidence intervals (CI) for outcome events were calculated by the fixed effects model, and trial sequential analysis was applied to assess the results. Result A total of ten randomized controlled trials and 60,782 patients with CAD was included. Compared with patients receiving placebo, anti-inflammatory therapy significantly reduced the incidence of the primary outcome in patients with CAD (RR 0.93, 0.89–0.98, P = 0.007). In addition, the anti-inflammatory therapy can also reduce the risk of MI (RR 0.90, 0.84–0.96, P = 0.002) and coronary revascularization (RR 0.74, 0.66–0.84, P < 0.00001) remarkably. However, there was no significant difference in the incidence of cardiovascular death (RR 0.94, 0.86–1.02, P = 0.14), all-cause death (RR 1.00, 0.94–1.07, P = 0.98) and stroke (RR 0.96, 0.85–1.09, P = 0.51) between two groups. Conclusions Anti-inflammatory therapy can reduce the incidence of the primary outcome in patients with CAD, especially the risk of MI and coronary revascularization. However, anti-inflammatory therapy increases the risk of infection. (Registered by PROSPERO, CRD 420212291032). Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02525-9.
Collapse
Affiliation(s)
- Ying Niu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Nan Bai
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ying Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Peng-Yu Zhong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yao-Sheng Shang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou, 730000, Gansu, China.
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Chen Y, Zhang H, Chen Y, Li M, Luo W, Liu Y, Fu Y, Xia H, Xu C, Jiang Y, Wu Y. Colchicine may become a new cornerstone therapy for coronary artery disease: a meta-analysis of randomized controlled trials. Clin Rheumatol 2022; 41:1873-1887. [PMID: 35138464 DOI: 10.1007/s10067-022-06050-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Colchicine is an ancient anti-inflammatory drug. In recent years, an increasing number of studies have shown that colchicine improves the prognosis of patients with coronary artery disease (CAD), while other studies have reported the opposite. The aim of this study was to evaluate the relative efficacy and safety of colchicine in treating CAD. METHODS PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched from inception to 20 October 2020 for randomized controlled trials (RCTs) comparing colchicine and placebo in patients with CAD. The primary outcomes were the primary composite outcomes of cardiovascular death, myocardial infarction (MI), ischemic stroke, or ischemia-driven coronary revascularization after colchicine administration. The secondary outcomes were cardiovascular death, death from any cause, noncardiac death, MI, ischemic stroke, coronary revascularization, gastrointestinal (GI) symptoms, and the different effects of colchicine in acute and chronic CAD. We assessed the pooled odds ratio (OR) of all-cause and cardiovascular mortality for CAD in fixed-effects models, the pooled risk ratio (RR) of the primary composite outcomes, MI, ischemic stroke, and ischemia-driven coronary revascularization in fixed-effects models and the pooled RR of GI symptoms in random-effects models. The Cochrane risk of bias tool was used to assess the risk of bias in the included RCTs. FINDINGS Eleven of the 894 identified studies (n = 12,899 patients) were included (6501 subjects in the colchicine group; 6389 subjects in the control group). The colchicine group had significantly lower pooled RRs of the primary composite outcomes (0.73, 95% confidence interval (CI) 0.64-0.84, P < 0.0001), MI (0.77, 95% CI 0.64-0.92, P = 0.004), ischemic stroke (0.47, 95% CI 0.30-0.76, P = 0.002), and ischemia-driven coronary revascularization (0.77, 95% CI 0.66-0.89, P = 0.0007), while the pooled RR of adverse GI events (2.15 95% CI 1.40-3.31, P = 0.0005) was significantly higher. Colchicine had a lower pooled RR of ischemic stroke (0.28, 95% CI 0.12-0.65, P = 0.003) for patients with acute compared with chronic CAD. IMPLICATIONS Colchicine treatment significantly decreased the risk of primary cardiovascular composite outcomes, MI, ischemic stroke, and ischemia-driven coronary revascularization in CAD patients but increased adverse GI events. There was no significant difference in all-cause mortality, cardiovascular mortality, and non-cardiovascular death between the colchicine and control groups. Colchicine performs better in acute CAD patients with ischemic stroke than chronic CAD patients. Colchicine might be a new treatment for patients with CAD.
Collapse
Affiliation(s)
- Yi Chen
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Hongzhou Zhang
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Yuxin Chen
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Meng Li
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Wei Luo
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Yue Liu
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Yang Fu
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Huasong Xia
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Cong Xu
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Yu Jiang
- Department of Cardiovascular Medicine, Donghu District, The First Affiliated Hospital of Nanchang University, No. 17, Yongzhengwai Road, Nanchang, 330006, Jiangxi, China
| | - Yanqing Wu
- Department of Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
27
|
Agnello F, Capodanno D. Anti-inflammatory strategies for atherosclerotic artery disease. Expert Opin Drug Saf 2022; 21:661-672. [DOI: 10.1080/14740338.2022.2036717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Federica Agnello
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| |
Collapse
|
28
|
Tang Y, Shi C, Qin Y, Wang S, Pan H, Chen M, Yu X, Lou Y, Fan G. Network Pharmacology-Based Investigation and Experimental Exploration of the Antiapoptotic Mechanism of Colchicine on Myocardial Ischemia Reperfusion Injury. Front Pharmacol 2022; 12:804030. [PMID: 34975499 PMCID: PMC8716846 DOI: 10.3389/fphar.2021.804030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The beneficial effects of colchicine on cardiovascular disease have been widely reported in recent studies. Previous research demonstrated that colchicine has a certain protective effect on ischemic myocardium and has the potential to treat myocardial ischemia reperfusion injury (MIRI). However, the potential targets and pharmacological mechanism of colchicine to treat MIRI has not been reported. Methods: In this study, we used network pharmacology and experimental verification to investigate the pharmacological mechanisms of colchicine for the treatment of MIRI. Potential targets of colchicine and MIRI related genes were screened from public databases. The mechanism of colchicine in the treatment of MIRI was determined by protein-protein interaction (PPI), gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Additionally, we evaluated the effect of colchicine on H9C2 cell activity using CCK-8 assays, observed the effect of colchicine on H9C2 cell apoptosis via flow cytometry, and further verified the expression of key targets after colchicine treated by Western blot. Results: A total of 626 target genes for colchicine and 1549 MIRI disease targets were obtained. 138 overlapping genes were determined as potential targets of colchicine in treating MIRI. the PPI network analysis demonstrated that the targets linked to MIRI were ALB, TNF, ACTB, AKT1, IL6, TP53, IL1B, CASP3 and these targets showed nice affinity with colchicine in molecular docking experiments. The results of GO analysis and KEGG pathway enrichment demonstrated that the anti-MIRI effect of colchicine involves in apoptotic signaling pathway. Further tests suggested that colchicine can protect H9C2 cell from Hypoxia/Reoxygenation (H/R) injury through anti-apoptotic effects. Western blot results demonstrated that colchicine can inhibited MIRI induced apoptosis of H9C2 cell by enhancing the decreased levels of Caspase-3 in myocardial injure model induced by H/R and activating the PI3K/AKT/eNOS pathway. Conclusions: we performed network pharmacology and experimental evaluation to reveal the pharmacological mechanism of colchicine against MIRI. The results from this study could provide a theoretical basis for the development and clinical application of colchicine.
Collapse
Affiliation(s)
- Yuanjun Tang
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenyang Shi
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Shuowen Wang
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Pan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Chen
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuemei Yu
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuefen Lou
- Department of Pharmacy, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Guorong Fan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
29
|
Deftereos SG, Beerkens FJ, Shah B, Giannopoulos G, Vrachatis DA, Giotaki SG, Siasos G, Nicolas J, Arnott C, Patel S, Parsons M, Tardif JC, Kovacic JC, Dangas GD. Colchicine in Cardiovascular Disease: In-Depth Review. Circulation 2022; 145:61-78. [PMID: 34965168 PMCID: PMC8726640 DOI: 10.1161/circulationaha.121.056171] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease.
Collapse
Affiliation(s)
- Spyridon G Deftereos
- Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.)
| | - Frans J Beerkens
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (F.J.B., J.N., J.C.K., G.D.D.)
| | - Binita Shah
- VA New York Harbor Healthcare System, New York University School of Medicine, New York (B.S.)
| | | | - Dimitrios A Vrachatis
- Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.)
| | - Sotiria G Giotaki
- Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.)
| | - Gerasimos Siasos
- Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.)
| | - Johny Nicolas
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (F.J.B., J.N., J.C.K., G.D.D.)
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.A.)
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Australia (C.A., S.P.)
| | - Sanjay Patel
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Australia (C.A., S.P.)
| | - Mark Parsons
- Department of Neurology, Liverpool Hospital and Ingham Institute for Applied Medical Research at South Western Sydney Clinical School, University of New South Wales, Australia (M.P.)
| | | | - Jason C Kovacic
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (F.J.B., J.N., J.C.K., G.D.D.)
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (J.C.K.)
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (J.C.K.)
| | - George D Dangas
- Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.)
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (F.J.B., J.N., J.C.K., G.D.D.)
| |
Collapse
|
30
|
Robinson PC, Terkeltaub R, Pillinger MH, Shah B, Karalis V, Karatza E, Liew D, Imazio M, Cornel JH, Thompson PL, Nidorf M. Consensus Statement Regarding the Efficacy and Safety of Long-Term Low-Dose Colchicine in Gout and Cardiovascular Disease. Am J Med 2022; 135:32-38. [PMID: 34416165 PMCID: PMC8688259 DOI: 10.1016/j.amjmed.2021.07.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
Over the last decade, evidence has demonstrated that long-term, low-dose colchicine (0.5 mg daily) is effective for preventing gout flare and cardiovascular (CV) events in a wide range of patients. Given the potentially expanding use of colchicine in CV disease, we here review and update the biologic effects and safety of colchicine based on recent data gathered from bench and pharmacodynamic studies, clinical reports, controlled clinical trials, and meta-analyses, integrated with important studies over the last 50 years, to offer a consensus perspective by experts from multiple specialties familiar with colchicine's long-term use. We conclude that the clinical benefits of colchicine in gout and CV disease achieved at low dose do not sustain serum levels above the upper limit of safety when used in patients without advanced renal or liver disease or when used concomitantly with most medications. Further, data accrued over the last 50 years strongly suggest that the biologic effects of long-term colchicine do not increase the risk of cancer, sepsis, cytopenia, or myotoxicity.
Collapse
Affiliation(s)
- Philip C Robinson
- University of Queensland School of Clinical Medicine, Faculty of Medicine, Herston, Qld, Australia; Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Qld, Australia.
| | | | | | - Binita Shah
- Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and NYU Langone Medical Center, New York, NY
| | - Vangelis Karalis
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karatza
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - David Liew
- Department of Clinical Pharmacology and Therapeutics and the Department of Rheumatology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Jan H Cornel
- Noordwest Ziekenhuisgroep, Alkmaar, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | |
Collapse
|
31
|
Hays AG, Schär M, Bonanno G, Lai S, Meyer J, Afework Y, Steinberg A, Stradley S, Gerstenblith G, Weiss RG. Randomized Trial of Anti-inflammatory Medications and Coronary Endothelial Dysfunction in Patients With Stable Coronary Disease. Front Cardiovasc Med 2021; 8:728654. [PMID: 34722661 PMCID: PMC8553961 DOI: 10.3389/fcvm.2021.728654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/14/2021] [Indexed: 12/03/2022] Open
Abstract
Aims: Inflammation plays a critical role in the pathogenesis of coronary artery disease (CAD), however the impact of anti-inflammatory therapies to reduce those processes which promote atherosclerosis in CAD patients is unknown. We aimed to test the hypothesis that anti-inflammatory approaches improve impaired coronary endothelial function (CEF), a driver of coronary atherosclerosis, in stable CAD patients. Methods and Results: We performed a single-center, randomized, placebo-controlled, double-blinded trial to assess whether low dose methotrexate (MTX), low dose colchicine (LDC), and/or their combination (MTX+LDC), improves CEF using non-invasive MRI measures in patients with stable CAD (N = 94). The primary endpoint was the MRI-detected change in coronary cross-sectional area from rest to isometric handgrip exercise (IHE), a predominantly nitric oxide-dependent endothelial dependent stressor. Coronary and systemic endothelial endpoints, and serum inflammatory markers, were collected at baseline, 8 and 24 weeks. Anti-inflammatory study drugs were well-tolerated. There were no significant differences in any of the CEF parameters among the four groups (MTX, LDC, MTX+LDC, placebo) at 8 or 24 weeks. Serum markers of inflammation and systemic endothelial function measures were also not significantly different among the groups. Conclusion: This is the first study to examine the effects of the anti-inflammatory approaches using MTX, LDC, and/or the combination in stable CAD patients on CEF, a marker of vascular health and the primary endpoint of the study. Although these anti-inflammatory approaches were relatively well-tolerated, they did not improve coronary endothelial function in patients with stable CAD. Clinical Trial Registration:www.clinicaltrials.gov, identifier: NCT02366091.
Collapse
Affiliation(s)
- Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gabriele Bonanno
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenghan Lai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joseph Meyer
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yohannes Afework
- Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Angela Steinberg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Samuel Stradley
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert G Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
32
|
Padda J, Khalid K, Almanie AH, Al Hennawi H, Mehta KA, Wijeratne Fernando R, Padda S, Cooper AC, Jean-Charles G. Hyperuricemia in Patients With Coronary Artery Disease and Its Association With Disease Severity. Cureus 2021; 13:e17161. [PMID: 34532188 PMCID: PMC8435271 DOI: 10.7759/cureus.17161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 12/02/2022] Open
Abstract
The biochemical background of coronary artery disease (CAD) has been intensively explored in the past several decades. Previous clinical investigations have demonstrated the association of non-traditional risk factors, such as hyperuricemia, with CAD. Studies have shown that increased serum uric acid (SUA) was associated with an increased risk of adverse cardiovascular (CV) outcomes in patients with CAD. While the exact pathophysiological mechanisms leading to increased risk are still unknown, it has been postulated that hyperuricemia leads to endothelial dysfunction, oxidative metabolism, and platelet adhesiveness and aggregation, leading to CAD. Moreover, previous studies have shown that hyperuricemia is an independent risk factor for CAD. However, the correlation between high SUA levels and the severity of CAD remains unclear. The purpose of this review was to elucidate the association of hyperuricemia to CAD severity and to determine the effect of urate-lowering therapy (ULT) on CAD. A search of PubMed up to June 24, 2021, was carried out by the reviewers. From the findings, hyperuricemia stands as an independent risk factor for CAD, and CAD patients treated with ULT had improved CV outcomes and reduced mortality. Therefore, while SUA level is valuable in predicting an augmented risk of CAD and anticipating worse outcomes, ULT has promising cardioprotective effects.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Gutteridge Jean-Charles
- Internal Medicine, JC Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
| |
Collapse
|
33
|
Zykov MV, Barbarash OL. Inflammation and Comorbidity. Are There any Chances to Improve the Prognosis in Patients with Extremely High Cardiovascular Risk? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-08-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The review contains actual data on possible approaches aimed at improving the prognosis in a special category of patients with extremely high cardiovascular risk, as well as in patients with recent acute coronary syndrome combined with comorbidity, including multifocal atherosclerosis. Currently, there are no class I recommendations for such patients aimed at reducing the risk of adverse cardiovascular events. It is suggested that suppression of inflammation may be a new therapeutic goal in this category of patients. Given the importance of inflammation in the development and course of atherosclerosis, in recent years there have been repeated attempts to influence the various components of the pro-inflammatory cascade involved in atherogenesis, but not all of them have been successful. Special attention is given to the anti-inflammatory effects of colchicine, a drug that can improve cardiovascular outcomes in patients with proven atherosclerosis. The review provides numerous pathogenetic and clinical evidence for the effectiveness of colchicine in patients with various manifestations of atherosclerosis. It is concluded that colchicine is the most promising anti-inflammatory drug that can improve the outcome of cardiovascular diseases. Thus, there is a need to initiate new clinical trial protocols aimed at studying the anti-inflammatory potential of this drug in patients with extreme cardiovascular risk.
Collapse
Affiliation(s)
- M. V. Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| |
Collapse
|
34
|
Abstract
Hyperuricemia and gout have been linked to an increased risk for cardiovascular (CV) disease, stroke, hypertension, heart failure, and chronic kidney disease, possibly through a proinflammatory milieu. However, not all the drugs used in gout treatment improve CV outcomes; colchicine has shown improved CV outcomes in patients with recent myocardial infarction and stable coronary artery disease independent of lipid-lowering effects. There is resurging interest in colchicine following publication of the COLCOT, LoDoCo, LoDoCo2, LoDoCo-MI trials, and COLCORONA trial which will shed light on its utility in COVID-19. Our aim is to review the CV use of colchicine beyond pericardial diseases, as well as CV outcomes of the available gout therapies, including allopurinol and febuxostat. The CARES trial and its surrounding controversies, which lead to the US FDA ‘black box’ warning on febuxostat, in addition to the recent FAST trial which contradicts this and finds febuxostat to be non-inferior, are discussed in this paper.
Collapse
|
35
|
Montarello NJ, Singh K, Sinhal A, Wong DTL, Alcock R, Rajendran S, Dautov R, Barlis P, Patel S, Nidorf SM, Thompson PL, Salagaras T, Butters J, Nerlekar N, Di Giovanni G, Ottaway JL, Nicholls SJ, Psaltis PJ. Assessing the Impact of Colchicine on Coronary Plaque Phenotype After Myocardial Infarction with Optical Coherence Tomography: Rationale and Design of the COCOMO-ACS Study. Cardiovasc Drugs Ther 2021; 36:1175-1186. [PMID: 34432196 PMCID: PMC8384919 DOI: 10.1007/s10557-021-07240-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 12/31/2022]
Abstract
Introduction Recurrent event rates after myocardial infarction (MI) remain unacceptably high, in part because of the continued growth and destabilization of residual coronary atherosclerotic plaques, which may occur despite lipid-lowering therapy. Inflammation is an important contributor to this ongoing risk. Recent studies have shown that the broad-acting anti-inflammatory agent, colchicine, may reduce adverse cardiovascular events in patients post-MI, although the mechanistic basis for this remains unclear. Advances in endovascular arterial wall imaging have allowed detailed characterization of the burden and compositional phenotype of coronary plaque, along with its natural history and responsiveness to treatment. One such example has been the use of optical coherence tomography (OCT) to demonstrate the plaque-stabilizing effects of statins on both fibrous cap thickness and the size of lipid pools within plaque. Methods The Phase 2, multi-centre, double-blind colchicine for coronary plaque modification in acute coronary syndrome (COCOMO-ACS) study will evaluate the effect of colchicine 0.5 mg daily on coronary plaque features using serial OCT imaging in patients following MI. Recruitment for the trial has been completed with 64 participants with non-ST elevation MI randomized 1:1 to colchicine or placebo in addition to guideline recommended therapies, including high-intensity statins. The primary endpoint is the effect of colchicine on the minimal fibrous cap thickness of non-culprit plaque over an 18-month period. Summary The COCOMO-ACS study will determine whether addition of colchicine 0.5 mg daily to standard post-MI treatment has incremental benefits on high-risk features of coronary artery plaques. If confirmed, this will provide new mechanistic insights into how colchicine may confer clinical benefits in patients with atherosclerotic cardiovascular disease. Trial Registration ANZCTR trial registration number: ACTRN12618000809235. Date of trial registration: 11th of May 2018.
Collapse
Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Australia
| | - Ajay Sinhal
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Dennis T L Wong
- Victorian Heart Institute, Monash University, Clayton, Australia
| | | | | | | | | | | | - Stefan M Nidorf
- GenesisCare Western Australia, Perth, Australia.,Heart and Vascular Research Institute of Western Australia, Perth, Australia
| | - Peter L Thompson
- GenesisCare Western Australia, Perth, Australia.,Heart and Vascular Research Institute of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Thalia Salagaras
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Julie Butters
- Victorian Heart Institute, Monash University, Clayton, Australia.,South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Nitesh Nerlekar
- Victorian Heart Institute, Monash University, Clayton, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Giuseppe Di Giovanni
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Juanita L Ottaway
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | | | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia. .,South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia. .,Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| |
Collapse
|
36
|
Abstract
Colchicine is a unique, sophisticated anti-inflammatory agent that has been used for decades for the prevention of acute inflammatory flares in gout and familial Mediterranean fever. In recent years, clinical trials have demonstrated its potential in a range of cardiovascular (CV) conditions. Colchicine is avidly taken up by leucocytes, and its ability to bind to tubulin and interfere with microtubular function affects the expression of cytokines and interleukins, and the ability of neutrophils to marginate, ingress, aggregate, express superoxide, release neutrophil extracellular traps, and interact with platelets. In patients with acute and recurrent pericarditis, clinical trials in >1600 patients have consistently shown that colchicine halves the risk of recurrence [relative risk (RR) 0.50, 95% confidence interval (CI) 0.42–0.60]. In patients with acute and chronic coronary syndromes, multicentre randomized controlled trials in >11 000 patients followed for up to 5 years demonstrated that colchicine may reduce the risk of CV death, myocardial infarction, ischaemic stroke and ischaemia-driven revascularization by >30% (RR 0.63, 95% CI 0.49–0.81). The use of colchicine at doses of 0.5–1.0 mg daily in CV trials has proved safe. Early gastrointestinal intolerance limits its use in ∼10% of patients; however, ∼90% of patients tolerate it well over the long term. Despite isolated case reports, clinically relevant drug interactions with moderate to strong CYP3A4 inhibitors/competitors or P-glycoprotein inhibitors/competitors are rare if this dosage of colchicine is used in the absence of advanced renal or liver disease. The aim of this review is to summarize the contemporary data supporting the efficacy and safety of colchicine in patients with CV disease.
Collapse
Affiliation(s)
- Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Mark Nidorf
- GenesisCare, 3/140 Mounts Bay Rd, Perth, Western Australia, Australia
| |
Collapse
|
37
|
Abstract
New therapeutic approaches are required for secondary prevention of residual vascular risk after stroke. Diverse sources of evidence support a causal role for inflammation in the pathogenesis of stroke. Randomized controlled trials of anti-inflammatory agents have reported benefit for secondary prevention in patients with coronary disease. We review the data from observational studies supporting a role for inflammation in pathogenesis of stroke, overview randomized controlled trials of anti-inflammatory therapy in cardiac disease and discuss the potential implications for stroke prevention therapy.
Collapse
Affiliation(s)
- Peter J Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Ireland (P.J.K.).,Health Research Board Stroke Clinical Trials Network Ireland (P.J.K.)
| | - Robin Lemmens
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Belgium (R.L.).,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium (R.L.).,Department of Neurology, University Hospitals Leuven, Belgium (R.L.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, Greece (G.T.)
| |
Collapse
|
38
|
OKTAY V, CIRALI IC, SARILAR M, MIRZAYEV K, JAFAROV U, ABACI O. The role of colchicine in preventing contrast-induced acute kidney injury in patients undergoing elective percutaneous coronary intervention. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
39
|
A randomized, placebo-controlled, double-blinded clinical trial of colchicine to improve vascular health in people living with HIV. AIDS 2021; 35:1041-1050. [PMID: 33587443 PMCID: PMC8916096 DOI: 10.1097/qad.0000000000002845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES People living with HIV (PWH) experience an increased burden of coronary artery disease (CAD) believed to be related, in part, to an interplay of chronically increased inflammation and traditional risk factors. Recent trials suggest cardiovascular benefits of the anti-inflammatory, colchicine, in HIV-seronegative CAD patients. However, the impact of colchicine on impaired vascular health, as measured by coronary endothelial function (CEF), an independent contributor to CAD, has not been studied in PWH. We tested the hypothesis that colchicine improves vascular health in PWH. DESIGN This was a randomized, placebo-controlled, double-blinded trial in 81 PWH to test whether low-dose colchicine (0.6 mg daily) improves CEF over 8-24 weeks. METHODS Coronary and systemic endothelial function and serum inflammatory markers were measured at baseline, and at 8 and 24 weeks. The primary endpoint was CEF, measured as the change in coronary blood flow from rest to that during an isometric handgrip exercise, an endothelial-dependent stressor, measured with non-invasive MRI at 8 weeks. RESULTS Colchicine was well tolerated and not associated with increased adverse events. However, there were no significant improvements in coronary or systemic endothelial function or reductions in serum inflammatory markers at 8 or 24 weeks with colchicine as compared to placebo. CONCLUSIONS In PWH with no history of CAD, low-dose colchicine was well tolerated but did not improve impaired coronary endothelial function, a predictor of cardiovascular events. These findings suggest that this anti-inflammatory approach using colchicine in PWH does not improve vascular health, the central, early driver of coronary atherosclerosis.
Collapse
|
40
|
Liberale L, Montecucco F, Tardif JC, Libby P, Camici GG. Inflamm-ageing: the role of inflammation in age-dependent cardiovascular disease. Eur Heart J 2021; 41:2974-2982. [PMID: 32006431 DOI: 10.1093/eurheartj/ehz961] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/10/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
The ongoing worldwide increase in life expectancy portends a rising prevalence of age-related cardiovascular (CV) diseases in the coming decades that demands a deeper understanding of their molecular mechanisms. Inflammation has recently emerged as an important contributor for CV disease development. Indeed, a state of chronic sterile low-grade inflammation characterizes older organisms (also known as inflamm-ageing) and participates pivotally in the development of frailty, disability, and most chronic degenerative diseases including age-related CV and cerebrovascular afflictions. Due to chronic activation of inflammasomes and to reduced endogenous anti-inflammatory mechanisms, inflamm-ageing contributes to the activation of leucocytes, endothelial, and vascular smooth muscle cells, thus accelerating vascular ageing and atherosclerosis. Furthermore, inflamm-ageing promotes the development of catastrophic athero-thrombotic complications by enhancing platelet reactivity and predisposing to plaque rupture and erosion. Thus, inflamm-ageing and its contributors or molecular mediators might furnish targets for novel therapeutic strategies that could promote healthy ageing and conserve resources for health care systems worldwide. Here, we discuss recent findings in the pathophysiology of inflamm-ageing, the impact of these processes on the development of age-related CV diseases, results from clinical trials targeting its components and the potential implementation of these advances into daily clinical practice.
Collapse
Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, v.le Benedetto XV 10, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, L.go Rosanna Benzi 10, 16132 Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, v.le Benedetto XV 10, 16132 Genoa, Italy
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montreal, Rue Bélanger 5000, Montreal, QC H1T 1C8, Canada
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Francis Street 75, Boston, MA 02115, USA
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, Schlieren CH-8952, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
41
|
Talaat M, Park K, Schlesinger N. Contentious Issues in Gout Management: The Story so Far. Open Access Rheumatol 2021; 13:111-122. [PMID: 34012303 PMCID: PMC8126966 DOI: 10.2147/oarrr.s282631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
Gout is the most common inflammatory arthritis worldwide. Although gout has been known for antiquity, many challenges still exist in gout management. It is vital to view gout as a chronic disease and not just treat the acute flare. There is a perception of gout as an acute disease requiring treatment only for acute flares. However, to combat the disease, chronic urate-lowering therapy, reducing the serum urate levels to below the saturation threshold of 6.8 mg/dL, and chronic anti-inflammatory prophylaxis, especially during urate-lowering therapy initiation, are needed. In this manuscript, we discuss some of the contentious issues in gout management. These include the timing of urate-lowering therapy initiation, which urate-lowering therapy to chose, should comorbidities influence our treatment, using genetic determinants, and patient perspectives to drive treatment and differences between gout treatment the American College of Physicians and Rheumatology guidelines for gout management: driving care.
Collapse
Affiliation(s)
- Mohamed Talaat
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kyle Park
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08903-0019, USA
| |
Collapse
|
42
|
Reyes AZ, Hu KA, Teperman J, Wampler Muskardin TL, Tardif JC, Shah B, Pillinger MH. Anti-inflammatory therapy for COVID-19 infection: the case for colchicine. Ann Rheum Dis 2021; 80:550-557. [PMID: 33293273 PMCID: PMC8491433 DOI: 10.1136/annrheumdis-2020-219174] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022]
Abstract
The search for effective COVID-19 management strategies continues to evolve. Current understanding of SARS-CoV-2 mechanisms suggests a central role for exaggerated activation of the innate immune system as an important contributor to COVID-19 adverse outcomes. The actions of colchicine, one of the oldest anti-inflammatory therapeutics, target multiple mechanisms associated with COVID-19 excessive inflammation. While many COVID-19 trials have sought to manipulate SARS-CoV-2 or dampen the inflammatory response once patients are hospitalised, few examine therapeutics to prevent the need for hospitalisation. Colchicine is easily administered, generally well tolerated and inexpensive, and holds particular promise to reduce the risk of hospitalisation and mortality due to COVID-19 in the outpatient setting. Successful outpatient treatment of COVID-19 could greatly reduce morbidity, mortality and the demand for rare or expensive care resources (front-line healthcare workers, hospital beds, ventilators, biological therapies), to the benefit of both resource-replete and resource-poor regions.
Collapse
Affiliation(s)
- Aaron Z Reyes
- Internal Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Kelly A Hu
- Internal Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jacob Teperman
- Internal Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Theresa L Wampler Muskardin
- Colton Center for Autoimmunity, Department of Medicine and Pathology, New York University School of Medicine, New York, New York, USA
- Rheumatology/Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Binita Shah
- Cardiology/Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Cardiology/Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Michael H Pillinger
- Rheumatology/Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Rheumatology/Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| |
Collapse
|
43
|
Samuel M, Tardif JC, Bouabdallaoui N, Khairy P, Dubé MP, Blondeau L, Guertin MC. Colchicine for Secondary Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Can J Cardiol 2021; 37:776-785. [DOI: 10.1016/j.cjca.2020.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
|
44
|
Shaya GE, Leucker TM, Jones SR, Martin SS, Toth PP. Coronary heart disease risk: Low-density lipoprotein and beyond. Trends Cardiovasc Med 2021; 32:181-194. [PMID: 33872757 DOI: 10.1016/j.tcm.2021.04.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
Coronary heart disease (CHD) is the leading cause of morbidity and mortality world-wide and has been characterized as a chronic immunoinflammatory, fibroproliferative disease fueled by lipids. Great advances have been made in elucidating the complex mechanistic interactions among risk factors associated with CHD, yielding abundant success towards preventive measures and the development of pharmaceuticals to prevent and treat CHD via attenuation of lipoprotein-mediated risk. However, significant residual risk remains. Several potentially modifiable CHD risk factors ostensibly contributing to this residual risk have since come to the fore, including systemic inflammation, diabetes mellitus, high-density lipoprotein, plasma triglycerides (TG) and remnant lipoproteins (RLP), lipoprotein(a) (Lp[a]), and vascular endothelial dysfunction (ED). Herein, we summarize the body of evidence implicating each of these risk factors in residual CHD risk.
Collapse
Affiliation(s)
- Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Thorsten M Leucker
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Community Hospital General Medical Center, Sterling, IL, USA.
| |
Collapse
|
45
|
Paul TK, Mukherjee D. Is Colchicine Beneficial for the Prevention of Cardiovascular Events After Myocardial Infarction? Angiology 2021; 72:501-502. [PMID: 33813881 DOI: 10.1177/00033197211007711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Timir K Paul
- Division of Cardiology, 4154East Tennessee State University, Johnson City, TN, USA
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, 37316Texas Tech University Health Sciences Center, El Paso, TX, USA
| |
Collapse
|
46
|
Katira A, Katira R. Colchicine in coronary artery disease. Postgrad Med J 2021; 98:718-721. [PMID: 33782205 DOI: 10.1136/postgradmedj-2020-139611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/10/2021] [Accepted: 02/20/2021] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Inflammation has been seen to be a key feature of atherosclerosis and CAD, with a raised C-reactive protein being a marker of poor prognosis. Thus, the role of anti-inflammatory agents has been investigated in CAD. Colchicine is a well-known, inexpensive drug with marked anti-inflammatory effects. Here, we discuss the role of colchicine in stable CAD and post-acute coronary syndrome. We suggest that colchicine may play a key role in prevention of cardiovascular events in patients with stable and unstable CAD as colchicine is associated with a reduction in the rate of myocardial infarction and other major cardiovascular outcomes.
Collapse
Affiliation(s)
- Arnav Katira
- Department of Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ravish Katira
- Cardiology Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| |
Collapse
|
47
|
Abdelmaseih R, Alsamman MM, Faluk M, Hasan SM. Cardiovascular Outcomes With Anti-Inflammatory Therapies: Review of Literature. Curr Probl Cardiol 2021; 47:100840. [PMID: 33994031 DOI: 10.1016/j.cpcardiol.2021.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 11/03/2022]
Abstract
Inflammation is a major contributing factor in the development of cardiovascular disease (CVD) and has been a popular topic of discussion as it provides a potential therapeutic target to reduce disease progression. Multiple inflammatory markers have been linked with progressive atherosclerosis which includes interleukin-6, tumor necrosis factor-α, C-reactive protein amongst others, this article aims to review current literature to evaluate the effectiveness of anti-inflammatory therapies in cardiovascular disease.
Collapse
Affiliation(s)
- Ramy Abdelmaseih
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL; Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, FL.
| | - M Mrhaf Alsamman
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL; Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, FL
| | - Mohammad Faluk
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL; Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, FL
| | - Syed Mustajab Hasan
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL; Ocala Regional Medical Center, Internal Medicine Residency Program, Ocala, FL
| |
Collapse
|
48
|
Ma J, Chen X. Anti-inflammatory Therapy for Coronary Atherosclerotic Heart Disease: Unanswered Questions Behind Existing Successes. Front Cardiovasc Med 2021; 7:631398. [PMID: 33598482 PMCID: PMC7882495 DOI: 10.3389/fcvm.2020.631398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023] Open
Abstract
Coronary atherosclerotic heart disease is a serious threat to human health. The results of the Canakinumab Anti-Inflammatory Thrombosis Outcome Study published in 2017 put an end to the perennial debate about the anti-inflammatory treatment of coronary atherosclerotic heart disease. In addition to interleukin 1β monoclonal antibody, interleukin 6 receptor antagonists and colchicine have also shown exciting results in clinical trials within the last 3 years. However, behind these successes, questions remain that need to be addressed. In this review, we summarize the successes and existing doubts of interleukin 1β antibodies, interleukin 6 receptor antagonists, and colchicine in the anti-inflammatory treatment of coronary atherosclerotic heart disease.
Collapse
Affiliation(s)
- Jun Ma
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
49
|
Kurup R, Galougahi KK, Figtree G, Misra A, Patel S. The Role of Colchicine in Atherosclerotic Cardiovascular Disease. Heart Lung Circ 2021; 30:795-806. [PMID: 33461916 DOI: 10.1016/j.hlc.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/10/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
Colchicine, an inexpensive immunomodulatory drug used traditionally to treat gout and familial Mediterranean fever, is rapidly accumulating basic and clinical evidence for a therapeutic role in atherosclerotic cardiovascular disease. Its athero-protective properties are thought to be mainly related to its effect on tubulin polymerisation, enabling a broad range of effect on multiple atherosclerotic plaque cell types and cellular processes, including cell division, cell migration as well as pro-inflammatory cytokine and chemokine secretion. These properties indicate the potential to favourably affect all stages of atherosclerotic plaque development including formation, progression, destabilisation, and plaque rupture. This review focusses on the pharmacology of colchicine, the mechanisms by which it modulates atherosclerosis pathobiology, and summarises the current clinical evidence for its use along with the upcoming clinical trial landscape. Given the current lack of primary immunomodulatory drugs in the treatment of atherosclerosis, colchicine is a promising candidate to fill this therapeutic gap.
Collapse
Affiliation(s)
- Rahul Kurup
- The Heart Research Institute, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. https://twitter.com/drrahulkurup
| | - Keyvan Karimi Galougahi
- The Heart Research Institute, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Gemma Figtree
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ashish Misra
- The Heart Research Institute, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sanjay Patel
- The Heart Research Institute, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
50
|
Tapoi L, Benchea L, Siriopol D, Kanbay M, Covic A. Colchicine Use in Acute Coronary Syndromes: An Update. Angiology 2021; 72:503-510. [PMID: 33412929 DOI: 10.1177/0003319720985644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coronary artery disease is the leading cause of death worldwide, and its main pathological substrate is represented by atherosclerosis. Inflammation is a major promoter of the atherosclerotic process and is involved in both the initiation and progression of atherosclerosis, as well as in the occurrence of fatal complications. Until the present moment, Colchicine Cardiovascular Outcomes Trial is the largest trial to demonstrate a major benefit of low-dose colchicine on major adverse cardiac events in patients with recent myocardial infarction (MI), but the mechanisms behind this relation are not completely known. The purpose of this review is to emphasize the possible pathways through which colchicine improves the clinical outcomes in the acute setting of acute coronary syndromes by referring to the results of the studies published in the past 5 years. Aside from its stated systemic anti-inflammatory effect, colchicine could be a valuable addition to the therapeutic approach of acute MI by reducing the infarct size, stabilizing the coronary plaque, as well as reducing platelet aggregation. Moreover, colchicine may improve endothelial function, reduce the transcoronary release of cytokines, and prevent a rise in inflammatory markers after percutaneous coronary intervention, thus diminishing the residual inflammatory risk.
Collapse
Affiliation(s)
- Laura Tapoi
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu," Iasi, Romania
| | - Laura Benchea
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu," Iasi, Romania
| | - Dimitrie Siriopol
- 162290"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, 52979Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Adrian Covic
- 162290"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, Iasi, Romania
| |
Collapse
|