Colchicine and the heart

Abstract

Colchicine is a unique, sophisticated anti-inflammatory agent that has been used for decades for the prevention of acute inflammatory flares in gout and familial Mediterranean fever. In recent years, clinical trials have demonstrated its potential in a range of cardiovascular (CV) conditions. Colchicine is avidly taken up by leucocytes, and its ability to bind to tubulin and interfere with microtubular function affects the expression of cytokines and interleukins, and the ability of neutrophils to marginate, ingress, aggregate, express superoxide, release neutrophil extracellular traps, and interact with platelets. In patients with acute and recurrent pericarditis, clinical trials in >1600 patients have consistently shown that colchicine halves the risk of recurrence [relative risk (RR) 0.50, 95% confidence interval (CI) 0.42–0.60]. In patients with acute and chronic coronary syndromes, multicentre randomized controlled trials in >11 000 patients followed for up to 5 years demonstrated that colchicine may reduce the risk of CV death, myocardial infarction, ischaemic stroke and ischaemia-driven revascularization by >30% (RR 0.63, 95% CI 0.49–0.81). The use of colchicine at doses of 0.5–1.0 mg daily in CV trials has proved safe. Early gastrointestinal intolerance limits its use in ∼10% of patients; however, ∼90% of patients tolerate it well over the long term. Despite isolated case reports, clinically relevant drug interactions with moderate to strong CYP3A4 inhibitors/competitors or P-glycoprotein inhibitors/competitors are rare if this dosage of colchicine is used in the absence of advanced renal or liver disease. The aim of this review is to summarize the contemporary data supporting the efficacy and safety of colchicine in patients with CV disease.

Consensus Statement Regarding the Efficacy and Safety of Long-Term Low-Dose Colchicine in Gout and Cardiovascular Disease

“…In the last decade, colchicine's properties have been explored for secondary prevention of cardiovascular (CV) disease. 1 Colchicine's action on such a wide range of conditions stems from its ability to dampen innate immune responses common to all. However, the specific mechanisms by which colchicine benefits each disease is not fully characterized.…”

Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…Inhibition of interleukin-1β with canakinumab could lower the NLR in a dose-dependent response and reduce cardiovascular events [ 47 , 48 ]. Colchicine, which can inhibit the inflammatory response mediated by monocytes and neutrophils, could reduce MACE in patients with CAD [ 49 , 50 ]. Methotrexate cannot reduce the inflammatory response and has no effects on cardiovascular events [ 51 ].…”

Efficacy and safety of colchicine in patients with acute coronary syndrome: A meta-analysis of randomized control trials

“…Considering the meta-analysis results, there are two points worth discussing: Colchicine can reduce the incidence of cardiovascular ischemia and MACE in ACS patient, but why does it not reduce cardiac death? consideration: cardiac death is caused by a combination of many factors, such as: myocardial ischemia, heart failure, malignant arrhythmia, cardiac rupture and infective endocarditis, colchicine mainly inhibit in ammation and atherosclerosis progress, to reduce the myocardial ischemia, but did not signi cantly reduce risk of other adverse factors 38 . However, the interference of follow-up duration cannot be ruled out, and the effect of colchicine on cardiac death may be found with further extension of followup duration.…”