Addressing Inflammation and Role of Colchicine in ASCVD, with Michael J. Blaha, MD, MPH

A leading killer in the US and abroad for years, atherosclerotic cardiovascular disease (ASCVD) represents one of the greatest threats to public health in modern history. However, in recent years revelations surrounding drivers and development of ASCVD have begun to signal cardiologists, and the medical community as a whole, could potentially turn the tide in the fight against ASCVD.

Among the most significant revelations has been the role of inflammation in driving cardiovascular risk. This recognition and subsequent emphasis on exploring the role of inflammation in ASCVD was on display at the American College of Cardiology 2023 Scientific Sessions, where Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, and a team of colleagues presented data from a 31,245-person analysis examining the residual risk associated with high-sensitivity C-reactive protein (hs-CRP) levels in statin-treated patients.¹

Results of the study, which was an analysis of pooled data from the PROMINENT, STRENGTH, and REDUCE-IT trials, suggested those in the highest quartile of hs-CRP had a statistically significant increase in risk for incident major adverse cardiovascular events (HR, 1.31; 95% CI, 1.20-1.43; P < .0001), cardiovascular mortality (HR, 2.68; 95% CI, 2.22-3.23; P < .0001), and all-cause mortality (HR, 2.42; 95% CI, 2.12-2.77; P < .0001) to relative to those in the lowest quartile. Additional analysis suggested the relationship of residual cholesterol risk was neutral for MACE and of low magnitude for cardiovascular death (HR, 1.27; 95% CI, 1.07-1.50; P = .0086) and all-cause mortality (HR, 1.16; 95% CI, 1.03-1.32; P = .025) when comparing those in the highest quartile of LDL-C against those in the lowest quartile.¹

Less than 4 months after this study demonstrated the risk associated with increased levels of hs-CRP, the US Food and Drug Administration approved the first anti-inflammatory atheroprotective cardiovascular treatment in colchicine 0.5 mg tablets (Lodoco). Marketed by AGEPHA Pharma, the agent was awarded an indication for reducing the risk of myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease.²

With such an elevated degree of advancement in recent years, guideline writing committees, and the cardiology community as a whole, will have to grapple with deciphering and applying these data to real-world populations, including the actualization of colchicine’s optimal role in treatment algorithms. With an interest in learning more about the potential of colchicine and potential hurdles to uptake in contemporary management settings, the editorial team of HCPLive Cardiology sat down with Michael J. Blaha, MD, MPH, director of Clinical Research in the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine.

Relevant disclosures for Dr. Blaha include AGEPHA Pharma, Amgen, Bayer Healthcare Pharmaceuticals, Kowa, Novartis Corporation, Novo Nordisk, and others.

References:

1. ^{Campbell P. New study indicates inflammation could be major driver of Atherosclerotic Risk. HCP Live. March 9, 2023. Accessed August 09, 2023. https://www.hcplive.com/view/new-study-indicates-inflammation-could-be-major-driver-of-atherosclerotic-risk.}
2. ^{Campbell P. FDA approves colchicine tablets for reducing cardiovascular risk. HCP Live. June 20, 2023. Accessed August 9, 2023. https://www.hcplive.com/view/fda-approves-colchicine-tablets-for-reducing-cardiovascular-risk.}