Author + information
- Received May 2, 2017
- Revision received August 3, 2017
- Accepted August 4, 2017
- Published online February 5, 2018.
- Kaivan Vaidya, MBBS, MMed(Clin Epi)a,
- Clare Arnott, MBBSa,b,
- Gonzalo J. Martínez, MDc,d,
- Bernard Ng, MBBSe,
- Samuel McCormack, MBChBe,
- David R. Sullivan, MDb,f,g,
- David S. Celermajer, MBBS, PhD, DSca,b,c and
- Sanjay Patel, MBBS, PhDa,b,c,f,∗ ()
- aDepartment of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- bSydney Medical School, The University of Sydney, New South Wales, Australia
- cThe Heart Research Institute, Sydney, New South Wales, Australia
- dDivision of Cardiovascular Diseases, Pontificia Universidad Católica Hospital, Santiago, Chile
- eDepartment of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- fCharles Perkins Centre, The University of Sydney, New South Wales, Australia
- gDepartment of Biochemistry, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- ↵∗Address for correspondence:
A/Prof. Sanjay Patel, Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW 2050, Australia.
Objectives The authors sought to evaluate the plaque-modifying effects of low-dose colchicine therapy plus optimal medical therapy (OMT) in patients post-acute coronary syndrome (ACS), as assessed by coronary computed tomography angiography (coronary CTA).
Background Colchicine therapy has been postulated to have beneficial anti-inflammatory effects in patients with ACS, translating into reduction in future adverse cardiovascular events. However, whether favorable plaque modification underpins this is yet unproven.
Methods In this prospective nonrandomized observational study of 80 patients with recent ACS (<1 month), patients received either 0.5 mg/day colchicine plus OMT or OMT alone and were followed for 1 year. Our primary outcome was change in low attenuation plaque volume (LAPV), a marker of plaque instability on coronary CTA and robust predictor of adverse cardiovascular events. Secondary outcomes were changes in other coronary CTA measures and in high-sensitivity C-reactive protein (hsCRP).
Results Mean duration of follow-up was 12.6 months; mean age was 57.4 years. Colchicine therapy significantly reduced LAPV (mean 15.9 mm3 [−40.9%] vs. 6.6 mm3 [−17.0%]; p = 0.008) and hsCRP (mean 1.10 mg/l [−37.3%] vs. 0.38 mg/l [−14.6%]; p < 0.001) versus controls. Reductions in total atheroma volume (mean 42.3 mm3 vs. 26.4 mm3; p = 0.28) and low-density lipoprotein levels (mean 0.44 mmol/l vs. 0.49 mmol/l; p = 0.21) were comparable in both groups. With multivariate linear regression, colchicine therapy remained significantly associated with greater reduction in LAPV (p = 0.039) and hsCRP (p = 0.004). There was also a significant linear association (p < 0.001) and strong positive correlation (r = 0.578) between change in LAPV and hsCRP.
Conclusions Our findings suggest, for the first time, that low-dose colchicine therapy favorably modifies coronary plaque, independent of high-dose statin intensification therapy and substantial low-density lipoprotein reduction. The improvements in plaque morphology are likely driven by the anti-inflammatory properties of colchicine, as demonstrated by reductions in hsCRP, rather than changes in lipoproteins. Colchicine may be beneficial as an additional secondary prevention agent in patients post-ACS if validated in future studies.
- acute coronary syndrome
- coronary artery disease
- CT coronary angiography
This work was supported by grants from Perpetual IMPACT Philanthropy. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 2, 2017.
- Revision received August 3, 2017.
- Accepted August 4, 2017.