‘Colchicine is useful for patients with heart disease’

New Delhi

The US FDA has confirmed that colchicine is useful for patients with heart disease. In randomized, placebo-controlled trials, colchicine was found to reduce adverse cardiovascular events by about 30%. It is useful for use in patients with coronary artery disease (CAD), including those with a history of angina, heart attack, angioplasty, stem implantation, or bypass surgery.

It was found to improve outcomes in patients with recent heart attacks, those with chronic stable CAD as well as those at high risk of CAD. This development has important implications for CAD patients all over the world since colchicum is an economical, easily available agent and hence will be widely used.

“It is 30% beneficial for an adverse cardiovascular event,” said Dr Rajiv Narang, department of Cardiology AIIMS. It is an established anti-inflammatory agent widely used for patients with gout helps decrease swelling and lessen the build-up of uric acid crystals that cause pain in the affected joint(s). This medication is also used to prevent attacks of pain in the abdomen, chest, or joints caused by a certain inherited disease (familial Mediterranean fever). But, now It was also tested and found to be useful for patient suffering CAD and also those patients who have no documented CAD but are at high risk for it as indicated by a high coronary calcium score. These recommendations are based on studies done on this agent over the last decade.

After aspirin and statin, it is only the third agent that has been shown to improve outcomes in stable patients with CAD with no history of heart attacks and preserved left ventricular function (the left ventricle is the main pumping chamber of the heart). For patients at high risk of CAD, it is only the second agent after statin to have shown convincing benefit.
Inflammation has long been thought to be important for atherosclerosis which leads to CAD, angina, heart attack, and stroke. The mechanism of action of colchicine, hence, is much different from the other two established agents, namely aspirin which prevents blood clotting, and statin whose main mechanism is lowering ox-blood cholesterol.

It is generally well tolerated in doses tested for use in patients with CAD. Gastrointestinal side effects like abdominal discomfort and diarrhea may occur in a small minority of patients. Those with kidney and liver disease need to be carefully monitored if this drug is used. Concomitant use of some other drugs like clarithromycin should also be avoided. Patients must consult their doctors before starting to take this drug.