According to a new study presented at the American Heart Association’s Scientific Sessions in Philadelphia and published online in November in the New England Journal of Medicine, heart attack survivors who took a 0.5 milligram (mg) daily pill of colchicine cut total risk of adverse heart events, including heart attack, stroke, cardiac arrest, urgent hospitalization to treat a blockage, and death from cardiovascular causes, by as much as 23 percent compared with patients who took a placebo. “We basically took an anti-inflammatory drug that has been used for decades in gout and repurposed it to test the hypothesis that it could reduce inflammation in the heart and help patients who had a recent heart attack,” says the lead study author of the study, Jean-Claude Tardif, MD, the director of research at the Montreal Heart Institute. “We were not only surprised by the magnitude of the benefit, but also by the fact that the drug was very well tolerated.” For this trial, Dr. Tardif and his collaborators selected 4,745 heart attack survivors who were an average age of 61: about a fifth were female, and a fifth had diabetes. Over about a year and 10 months, half the patients received a half-milligram dose of colchicine daily and half received a placebo. While 7.1 percent of patients in the placebo group died of a cardiovascular event or had a second heart attack, a stroke, or hospitalization, such complications occurred in only 5.5 percent of the colchicine group. The pill also cut the odds of death from any cardiovascular event by 16 percent, halved the likelihood of patients being hospitalized for coronary bypass or stenting, and reduced the risk of stroke by 74 percent. Almost all the participants in both groups were also taking aspirin and a second anti-platelet agent to prevent blood clots, as well as a statin to treat cholesterol. The trial demonstrated that colchicine safely added benefit over and above the drugs that patients were already taking, according to Tardif.
The Potential to Treat Other Heart Problems
Colchicine is originally derived from the autumn crocus (commonly called the “naked lady”) and knowledge of its anti-inflammatory properties dates back thousands of years, when it was used by Egyptian, Greek, and Arabic physicians. The study presented at the Scientific Sessions clearly shows the potential this ancient medicine has today. Researchers noted, though, that the drug does come with an increased risk of pneumonia, which appeared in 0.9 percent of colchicine patients. “At the Heart Association meeting, some people asked if it is going to be the new aspirin for patients with heart disease,” says Tardif. The answer depends on more research.
Research Suggests Other Potential Uses for the Drug
The doctor stresses that this trial is focused only on heart attack patients. He and his team, however, are launching a large new study to see how colchicine may reduce inflammation in patients with diabetes who have never suffered a heart attack. Another colchicine study presented at the Scientific Sessions found that the medication reduced inflammation after percutaneous coronary intervention (a catheter-based procedure to insert a stent) but it did not reduce the risk of related heart injury. Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas, points out that previous research has proved the medication to be effective in treating inflammation of the lining of the heart, a condition called pericarditis. “Clearly, we need more data, and I’m sure this study will lead to more lines of research, including trying to understand how colchicine can lower stroke risk, how long to continue therapy, and whether there are certain patients that might benefit more than others,” says Dr. Samaan, who was not involved in the research. “Heart disease, and heart attacks in particular, are strongly connected to inflammation, and colchicine is known for its anti-inflammatory effects.” Eugenia Gianos, MD, the director of cardiovascular prevention at Northwell Health in New York City, suggests that questions remain about the optimal dosing of the drug and which patient populations will have the best outcomes. “Higher risk patients with greater inflammation at baseline are more likely to benefit,” says Dr. Gianos, who was not a study investigator. Because this trial lasted only about 22 months, Tardif would like to get longer-term results to see if benefits persist. That said, he emphasizes that the results so far are “good news” for heart attack patients: “You have a drug that is orally administered, inexpensive, safe, that is going to prevent bad outcomes to patients who had heart attacks.”
