TY - JOUR
T1 - Colchicine in ischemic heart disease: the good, the bad and the ugly
AU - D’Amario, Domenico
AU - Cappetta, Donato
AU - Cappannoli, Luigi
AU - Princi, Giuseppe
AU - Migliaro, Stefano
AU - Diana, Giovanni
AU - Chouchane, Karim
AU - Borovac, Josip A.
AU - Restivo, Attilio
AU - Arcudi, Alessandra
AU - De Angelis, Antonella
AU - De Angelis, Aniello
AU - Vergallo, Rocco
AU - Montone, Rocco Antonio
AU - Galli, Mattia
AU - Liuzzo, Giovanna
AU - Crea, Filippo
PY - 2021
Y1 - 2021
N2 - Inflammation is the main pathophysiological process involved in atherosclerotic plaque formation, progression, instability, and healing during the evolution of coronary artery disease (CAD). The use of colchicine, a drug used for decades in non-ischemic cardiovascular (CV) diseases and/or systemic inflammatory conditions, stimulated new perspectives on its potential application in patients with CAD. Previous mechanistic and preclinical studies revealed anti-inflammatory and immunomodulatory effects of colchicine exerted through its principal mechanism of microtubule polymerization inhibition, however, other pleiotropic effects beneficial to the CV system were observed such as inhibition of platelet aggregation and suppression of endothelial proliferation. In randomized double-blinded clinical trials informing our clinical practice, low doses of colchicine were associated with the significant reduction of cardiovascular events in patients with stable CAD and chronic coronary syndrome (CCS) while in patients with a recent acute coronary syndrome (ACS), early initiation of colchicine treatment significantly reduced major adverse CV events (MACE). On the other hand, the safety profile of colchicine and its potential causal relationship to the observed increase in non-CV deaths warrants further investigation. For these reasons, postulates of precision medicine and patient-tailored approach with regards to benefits and harms of colchicine treatment should be employed at all times due to potential toxicity of colchicine as well as the currently unresolved signal of harm concerning non-CV mortality. The main goal of this review is to provide a balanced, critical, and comprehensive evaluation of currently available evidence with respect to colchicine use in the setting of CAD.
AB - Inflammation is the main pathophysiological process involved in atherosclerotic plaque formation, progression, instability, and healing during the evolution of coronary artery disease (CAD). The use of colchicine, a drug used for decades in non-ischemic cardiovascular (CV) diseases and/or systemic inflammatory conditions, stimulated new perspectives on its potential application in patients with CAD. Previous mechanistic and preclinical studies revealed anti-inflammatory and immunomodulatory effects of colchicine exerted through its principal mechanism of microtubule polymerization inhibition, however, other pleiotropic effects beneficial to the CV system were observed such as inhibition of platelet aggregation and suppression of endothelial proliferation. In randomized double-blinded clinical trials informing our clinical practice, low doses of colchicine were associated with the significant reduction of cardiovascular events in patients with stable CAD and chronic coronary syndrome (CCS) while in patients with a recent acute coronary syndrome (ACS), early initiation of colchicine treatment significantly reduced major adverse CV events (MACE). On the other hand, the safety profile of colchicine and its potential causal relationship to the observed increase in non-CV deaths warrants further investigation. For these reasons, postulates of precision medicine and patient-tailored approach with regards to benefits and harms of colchicine treatment should be employed at all times due to potential toxicity of colchicine as well as the currently unresolved signal of harm concerning non-CV mortality. The main goal of this review is to provide a balanced, critical, and comprehensive evaluation of currently available evidence with respect to colchicine use in the setting of CAD.
KW - Anti-Inflammatory Agents
KW - Atherosclerosis
KW - Cardiovascular events
KW - Colchicine
KW - Coronary Artery Disease
KW - Efficacy and safety
KW - Humans
KW - Inflammation
KW - Ischemic heart disease
KW - Myocardial Ischemia
KW - Personalized medicine
KW - Plaque, Atherosclerotic
KW - Randomized Controlled Trials as Topic
KW - Tailored therapy
KW - Anti-Inflammatory Agents
KW - Atherosclerosis
KW - Cardiovascular events
KW - Colchicine
KW - Coronary Artery Disease
KW - Efficacy and safety
KW - Humans
KW - Inflammation
KW - Ischemic heart disease
KW - Myocardial Ischemia
KW - Personalized medicine
KW - Plaque, Atherosclerotic
KW - Randomized Controlled Trials as Topic
KW - Tailored therapy
UR - http://hdl.handle.net/10807/204569
U2 - 10.1007/s00392-021-01828-9
DO - 10.1007/s00392-021-01828-9
M3 - Article
SN - 1861-0684
VL - 110
SP - 1531
EP - 1542
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
ER -