In a nutshell
This study investigated the safety and effectiveness of low-dose colchicine (Colcrys) after a heart attack.
They found that colchicine reduced the risk of ischemic cardiovascular events in these patients.
Some background
Coronary artery disease (CAD) is caused by reduced blood flow to the heart. Atherosclerosis (ATS) can lead to CAD. ATS is an event where plaques form in the arteries. Plaques are made of fats like cholesterol and other substances found in the blood. Plaques become hard and narrow the arteries. This reduces blood flow to the heart. Reduced blood flow leads to reduced oxygen (ischemia). This can lead to heart attacks and/or stroke. When these cardiovascular events (CVEs) are caused by ischemia they are called ischemic CVEs.
The build-up of cholesterol causes inflammation. This increases the size of the plaque. Treating ATS with an anti-inflammatory drug may reduce plaque size. Colchicine is a drug reduces inflammation via multiple mechanisms. It is commonly used in acute inflammatory conditions such as gout and pericarditis. One study suggests that a low dose of colchicine may reduce the risk of CVEs. It is unclear if colchicine is safe and effective in preventing ICVEs after a heart attack.
Methods & findings
This study included 4745 patients who had a heart attack. Patients were enrolled in this study about 2 weeks after initial treatment for the heart attack. Patients were randomly assigned to 0.5 mg colchicine or placebo (inactive tablet). The main outcome was the rate of ICVEs. Side effects were also recorded.
7.1% of patients in the placebo group had an ICVE. This compared to 5.5% of colchicine-treated patients. The risk of ICVEs was 23% lower in colchicine-treated patients. There were slightly smaller risks of death, heart attack or stroke associated with colchicine compared to placebo.
Side effects rates were similar in both groups. The most common side effect was diarrhea. Nausea and pneumonia were more common in colchicine-treated patients.
The bottom line
The authors concluded that low-dose colchicine reduced the risk of ICVEs.
The fine print
The average follow-up time was 22.6 months. The long-term safety of colchicine is unclear.
What’s next?
If you have any concerns regarding CAD management please discuss with your physician.
Published By :
The New England Journal of Medicine
Date :
Nov 16, 2019
