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Unmasking the Hidden Enemy: Inflammation's Role in Cardiovascular Disease

Cardiovascular diseases (CVDs) have long been a significant health concern, but advancements in statin therapy have helped reduce their impact. However, some patients continue to experience CVD events despite high-dose statin treatment. This is known as residual risk. Recent research suggests that this residual risk may be attributed, in part, to inflammation, which can trigger plaque ruptures. Here, we will delve into inflammation’s role in cardiovascular disease and explore the potential benefits of reducing inflammation using low-dose colchicine.

Inflammation’s role in Cardiovascular Disease

Inflammation has emerged as a key player in the development and progression of cardiovascular disease. Dr. Ridker and his team pioneered the use of high-sensitivity C-reactive protein (hs-CRP) testing to identify inflammation in patients. Their study, the Jupiter study, demonstrated the efficacy of rosuvastatin in reducing CV events in high-risk primary prevention patients identified through hs-CRP testing. However, the full potential of the inflammation strategy was not realised at that time and the potential to treat lower-risk patients was missed.

Uncovering the Link between Inflammation and CV Events

A recent paper explored the connection between inflammation and CV events by analysing data from three major studies: PROMINENT, REDUCE-IT, and STRENGTH. Patients were divided into quartiles based on their hs-CRP levels, and the highest quartile group was compared to the lowest.

The results were striking. Patients in the highest hs-CRP quartile experienced a 31% increase in major adverse cardiovascular events (MACE), a 268% increase in cardiovascular mortality, and a 242% increase in all-cause mortality, highlighting the significant impact of inflammation on CV health. Comparatively, the differences in MACE, CV death, and all-cause death were not as pronounced when comparing the highest and lowest LDL-cholesterol (LDL-C) quartiles. 

The Inflammation Conundrum

Once patients are on effective statin therapies and their LDL-C levels are well-controlled, the threat posed by LDL-C diminishes. However, the presence of inflammation remains a driving force behind future CV events. Identifying patients with high hs-CRP levels while on high-dose statins becomes essential to intensify efforts in reducing their residual CV risk.

Addressing Inflammation: A New Frontier in Cardiovascular Health:

Presently, there are limited affordable therapies proven to reduce inflammation. As a result, it is crucial to prioritise preventive measures that can help combat inflammation and its consequences. Encouraging patients to quit smoking, manage abdominal obesity, reduce stress, improve sleep quality, and adopt a heart-healthy diet can significantly contribute to reducing inflammation and enhancing overall cardiovascular health. 

The Concern of Inflammation Post COVID-19

The aftermath of long COVID poses another concern, as inflammation from COVID-19 may also increase the risk of cardiovascular events in a large number of people. Vigilance and proactive management of inflammation in recovering COVID-19 patients are paramount to safeguard their heart health.

The Power of Low-Dose Colchicine

Colchicine has been used for centuries to treat joint inflammation and is frequently used to treat gout.  A recent analysis has shed light on the potential of low-dose colchicine, revealing its significant impact in the management of chronic coronary artery disease by reducing inflammation in the coronary arteries. 

The study conducted an in-depth analysis to model the 10-year and lifetime impact of low-dose colchicine in patients with chronic coronary artery disease. The results were striking, demonstrating that low-dose colchicine has the potential to bring about a median 10-year absolute risk reduction rate of 4.6% for major adverse cardiovascular events (MACE). This reduction in risk translates into gaining 2.0 MACE-free years over a lifetime for patients.

What makes this finding even more significant is that the estimated 10-year and lifetime benefits of low-dose colchicine are comparable to the benefits associated with intensified low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure-lowering. LDL-C and blood pressure optimisation are well-established strategies in cardiovascular management, and the fact that low-dose colchicine holds similar potential is indeed promising news.

An exciting opportunity for patients with existing chronic coronary artery disease

The discovery of the potential benefits of low-dose colchicine presents an exciting opportunity for patients with existing chronic coronary artery disease. By adding this medication to their treatment regimen, they may experience substantial improvements in their cardiovascular health, with a reduced risk of MACE over the long term.

Low-dose colchicine is well-tolerated and has been used for years to treat conditions like gout. As always, individual patient needs vary, and decisions about treatment should be made in consultation with healthcare providers. When managing chronic coronary artery disease, healthcare providers will consider various factors, including a patient’s medical history, risk profile, and other existing treatments. By adopting a personalised approach to care, patients can receive the most suitable treatment plan that aligns with their unique health requirements.

Hope for a healthier & heart-protected future

Inflammation has emerged as a critical factor in the pathogenesis of cardiovascular disease, even when LDL-C levels are well-controlled through statin therapy. Identifying patients with inflammation through hs-CRP testing can help us address their residual CV risk and implement personalised strategies to reduce inflammation. The analysis of low-dose colchicine’s impact on chronic coronary artery disease has revealed its potential to significantly reduce the risk of major adverse cardiovascular events by reducing coronary artery inflammation. The estimated 10-year and lifetime benefits are on par with those of established cardiovascular therapies like LDL-C and blood pressure optimisation. Low-dose colchicine offers an exciting new option for enhancing cardiovascular health, providing patients with hope for a healthier and heart-protected future.

If you have chronic coronary artery disease

If you have chronic coronary artery disease, consider discussing the potential benefits of low-dose colchicine with your healthcare provider. Together, you can create a tailored treatment plan that best suits your needs, helping you embark on a journey towards improved cardiovascular well-being. Remember, your heart health is paramount, and with the right care and support, you can take positive steps to protect your heart and live a fulfilling life.

Please reach out to the team if you have any questions about the contents of this article.

Dr Hugh Coyne, co-founder Coyne Medical