Could an anti-inflammatory drug help prevent heart attacks?

According to Winslow, research has found a link between inflammation in the coronary arteries and the risk of heart attacks. Chronic inflammation can contribute to atherosclerosis, an artery-clogging disease. As fatty plaque builds up in the artery walls, they can sometimes rupture, leading to a heart attack.  

Now, FDA has approved the first-ever drug to treat cardiovascular inflammation, giving patients a potential new way to reduce their risk of heart attacks. The drug, which is called colchicine, is already used to treat several other ailments, including gout, a genetic disorder familial Mediterranean fever, and pericarditis.

Over the last few years, several different research teams have presented positive results on the effects of colchicine on heart attack risk.

A randomized, double-blind study of 5,222 patients with stable cardiovascular disease found that colchicine reduced the relative risk of cardiovascular events by 31%. Similarly, a study of 4,745 patients who received colchicine in addition to statin therapy reported a 23% reduction in risk.

Lodoco, a 0.5-milligram dose of colchicine approved for cardiovascular risk reduction, was launched in the United States earlier this month. Agepha Pharma, which acquired the rights to market Lodoco, has listed its price at $99 a month and is currently in negotiations regarding insurance coverage.

"We're a small company trying to do big things for patients," said Antonia Riel-Köllmann, Agepha's managing director.

Currently, colchicine is the only approved medication to target cardiovascular inflammation, but several other drug companies, including Novo Nordisk, are also working on new inflammatory drugs to reduce the risk of heart attacks.

How new drugs can help cardiologists personalize treatments

As new drugs become available, cardiologists will be able to personalize treatments for their high-risk patients. In addition to colchicine, new diabetes and weight-loss drugs, such as Novo Nordisk's Wegovy, could reduce the risk of serious cardiovascular events.

"The pivot here is to precision cardiology as opposed to one-size-fits-all cardiology," said Richard Kovacs, a professor at Indiana School of Medicine, Indianapolis and CMO of the American College of Cardiology. Instead of focusing only on lowering cholesterol for patients already on statins, "we need to tailor treatment to the individual risk factors of the patient."

According to Michael Blaha, director of clinical research at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, doctors could measure several risk factors, including inflammation, cholesterol, diabetes, and weight, to identify which one is impacting a patient the most and then prescribing a specific drug to target that risk.

"Preventive cardiology is undergoing a renaissance," Blaha said. "We can do more than ever for our patients who have high risk."

Potential obstacles to colchicine's use

Although colchicine could be a cheap and safe option for many patients, health experts say that doctors may be slow to prescribe it.

Colchicine "is not for everybody," said Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital. For example, it is not recommended for patients with kidney or liver disease.

In addition, updated guidelines from the American College of Cardiology and the American Heart Association only gave colchicine a weak endorsement. In the guidelines, the organization said that the drug "may be considered" as an option to reduce "recurrent" cardiovascular events. Colchicine should also be limited to very high-risk patients "until further data becomes available," due to potential interactions with other drugs and a small increase in non-heart-related deaths.

"I think it is going to have a role to play, but it's going to come after we've done other things we can do," said Steven Nissen, chief academic officer at Cleveland Clinic's Heart Institute. (Winslow, Wall Street Journal, 9/23)

We gathered 73 cardiovascular leaders to learn their most innovative strategies in CV care. Learn which 8 strategies were voted most creative and effective.