Colchicine in the prevention of cardiovascular events after myocardial infarction

Colchicine after a myocardial infarction helps reduce the risk of subsequent ischemic events. These are the conclusions, in summary, of a recent study published in the New England Journal of Medicine.

Research has shown that this anti-inflammatory drug is able to counteract the complications of atherosclerosis, in its most active phases.

New life for colchicine

Colchicine is a drug of natural origin, extracted from the plant Colchicum autumnale, already used by the ancient Egyptians to treat rheumatism. Only later was its use directed to gout treatment.

The mechanisms underlying its anti-inflammatory action are many and range from inhibition of neutrophil migration, to microtubule polymerization inhibition, and to interleukin-1β and mast cell degranulation inhibition.

All these anti-inflammatory mechanisms are active on the irritative phenomena caused by urate crystals deposited in the joints and causing gout.

Besides its use in this field, colchicine is indicated in cases of acute or recurrent pericarditis.

Colchicine and atherosclerosis

Inflammation plays an important role in the pathophysiological processes involved in atherosclerosis. Based on this principle, different studies have tried to use various anti-inflammatory drugs in patients with atherosclerotic events. However, the results have been controversial.

This time the drug tested, with a randomized and controlled experimental design, was colchicine.

The study included over 4,000 patients who had suffered a myocardial infarction within the previous 30 days. They assumed colchicine at a dose of 0.5 mg/day or placebo and were followed for a median period of 22.6 months.

The primary endpoint was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to a coronary revascularization procedure.

Favorable effects

The primary endpoint occurred more frequently in the placebo group (7.1% versus 5.5%). Analyzing the results for the single events included in the primary endpoint, it emerged that the hazard ratios were 0.84 for death from cardiovascular causes, 0.83 for cardiac arrest and 0.91 for myocardial infarction. Particularly indicative hazard ratios have also been shown for stroke (0.26) and hospitalization with revascularization (0.50).

Regarding treatment safety, the only serious adverse event found to be significantly higher in the group of patients treated with colchicine was pneumonia (0.9% versus 0.4%).

One more weapon

This international multicenter trial on colchicine, funded by the government of Quebec, shows very positive results in contrasting cardiovascular events following a myocardial infarction.

The only limit of the study is the relatively short follow-up, which continued for about two years. In this period, however, the protective effects of the drug, although administered at a low dose, seem clearly demonstrated.

Perhaps it is precisely colchicine, one of the oldest anti-inflammatory drugs known, the molecule we were waiting for, to adequately affect the inflammatory processes related to atherosclerosis. An additional weapon to combat cardiovascular events in high-risk patients.

 

 

https://www.nejm.org/doi/full/10.1056/NEJMoa1912388?query=featured_home

 

This post is also available in: Chinese (Simplified)

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