Targeting Inflammation to Treat Coronary Artery Disease

By Douglas L. Jennings, PharmD, FACC, FAHA, FCCP, FHFSA, BCPS 

Volume 2, Issue 3

Despite optimal medical therapy—which commonly consists of a cocktail of cardioprotective agents such as antiplatelet, statin, and antihypertensive medications—a significant number of patients with coronary artery disease (CAD) will experience a major adverse cardiovascular event. Inflammation plays a pivotal role in all stages of atherosclerosis, from initiation through progression, and ultimately may contribute to the ongoing complications of CAD. Colchicine has recently emerged as a promising novel therapeutic option for cardiovascular disease owing to its potent anti-inflammatory properties, which are likely exerted through a variety of mechanisms that leads to inhibition of innate immunity and modulation of downstream inflammatory cascades. In this week’s issue of Talking Therapeutics, we explore the evidence supporting colchicine to further reduce residual disease burden in CAD patients.

Point 1: Colchicine IS effective

Recently, a meta-analysis of five trials that included 11,816 patients found that low-dose (ie 0.5 mg/day) of colchicine reduced the risk for myocardial infarction by 22% (RR, 0.78; p = 0.010), stroke by 46% (RR, 0.54; P = 0.009), and coronary revascularization by 23% (RR, 0.77; 95% CI, 0.66–0.90; P < 0.001) (). Rates of cardiovascular death and overall death were not affected by colchicine, and no long-term safety signals were seen. The bottom line is this well-conducted meta-analysis of predominantly older, male patients strongly suggests that low-dose colchicine lowers the risk of recurrent CV events among a broad spectrum of patients with coronary artery disease (include those with acute coronary syndromes). It is highly likely that in light of these findings the next iteration of the ACC/AHA guidelines for stable CAD will include some recommendations supporting the use of colchicine in selected patients.

Point 2: Mind your colchicine Ps and Qs

As pharmacists, we need to keep several things in mind when dispensing colchicine to ensure that patients are kept safe:

• Colchicine is renally cleared. While the dose used in CAD patients is already low, pharmacists should take care in monitoring kidney function to ensure that patients with renal impairment are not intentionally overdosed.
• Colchicine has many drug interactions, include statin medications, which pharmacists must help to manage. Here is a link to an ACC tutorial on cardiovascular drug interactions with colchicine
• Colchicine can cause significant GI side effects, even in low doses. Pharmacists should counsel patients about common side effects with colchicine and advise patients on when to seek follow up care.

Dr Jennings is currently an Associate Professor of Pharmacy at Long Island University and the clinical pharmacist for the Heart Transplant and LVAD teams at New York- Presbyterian Hospital Columbia University Irving Medical Center.  He is an active researcher in his field, and he has published over 120 peer-reviewed abstracts and manuscripts, primarily focusing on the pharmacotherapy of patients under mechanical circulatory support. As a recognized expert in this area, he has been invited to speak at numerous national and international venues, including meetings in France, Saudia Arabia, India. Finally, Dr. Jennings has been active in professional organizations throughout his career. He is a fellow of the American College of Clinical Pharmacy, the American College of Cardiology, the Heart Failure Society of America, and the American Heart Association.  

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