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Colchicine in Stable Coronary Artery Disease

Aernoud T L Fiolet1, Stefan M Nidorf2, Arend Mosterd3

  • 1Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands; Dutch Network for Cardiovascular Research (WCN), Utrecht, the Netherlands.

Clinical Therapeutics
|November 7, 2018
PubMed

Insights

Colchicine, an anti-inflammatory drug, shows promise in preventing coronary artery disease plaque rupture. Ongoing trials will determine if it becomes a key treatment alongside lipid regulation and platelet inhibition.

Area of Science:

  • Cardiology
  • Pharmacology
  • Inflammation

Background:

  • Stable coronary artery disease (CAD) management focuses on hemostasis and lipids, lacking strategies to prevent plaque erosion or rupture.
  • Cholesterol crystal-induced inflammation is a key factor in plaque destabilization, suggesting anti-inflammatory drugs as a potential treatment.
  • Colchicine possesses anti-inflammatory properties that may target direct and indirect inflammatory mechanisms within atherosclerotic plaques.

Purpose of the Study:

  • To review current literature and ongoing clinical trials on colchicine's efficacy in stable coronary artery disease (CAD).
  • To assess the potential of colchicine as a therapeutic agent for secondary prevention in CAD by targeting inflammation.

Main Methods:

  • A comprehensive literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane) and clinical trial registries.
  • The search focused on identifying completed and ongoing clinical studies investigating colchicine in patients with stable coronary artery disease.

Main Results:

  • Preclinical studies and retrospective gout patient data suggest colchicine may reduce myocardial infarction size and restenosis.
  • One prospective randomized trial indicated a potential protective effect of colchicine in stable CAD.
  • Meta-analyses show a decrease in myocardial infarction with colchicine use across various cardiovascular diseases.
  • Five major clinical trials (>10,000 patients) are currently recruiting to evaluate colchicine's impact on major cardiovascular outcomes.

Conclusions:

  • Evidence on colchicine's efficacy for secondary prevention in stable and acute CAD is rapidly expanding.
  • Colchicine's anti-inflammatory action may improve event-free cardiovascular survival.
  • If proven effective, colchicine could become a third major pillar in stable CAD management, alongside lipid regulation and platelet inhibition.
Abstract

Keywords:
anti-inflammatory drugsclinical trialscolchicinecoronary artery diseasedrug rediscoverymyocardial infarction

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