Colchicine treatment reduces coronary plaque following ACS

Low-dose colchicine therapy can favorably remodel coronary plaque following acute coronary syndrome (ACS), reducing one of the major predictors of future cardiovascular events, according to a new study in JACC: Cardiovascular Imaging.

Kaivan Vaidya, MBBS, with the department of cardiology at Royal Prince Alfred Hospital in Sydney, and colleagues studied 80 nonrandomized patients who had presented with ACS within the previous month. Half of the patients received optimal medical therapy (OMT) plus 0.5 milligrams per day of colchicine, while the other half received OMT alone.

All of the patients—who were 77.5 percent men and 57 years old on average—were assessed via coronary CT angiography at baseline and one year later.

The group on colchicine therapy showed a 40.9 percent reduction in low attenuation plaque volume (LAPV) and a 37.3 percent reduction in high-sensitivity C-reactive protein (hsCRP). The control group experienced reductions of 17.0 percent and 14.6 percent, respectively, for LAPV and hsCRP. Reductions in total atheroma volume and low-density lipoprotein levels were comparable in both groups.

“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,” Vaidya and colleagues wrote. “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.”

Colchicine, an anti-inflammatory medication most often used to treat or prevent gout, has been hypothesized to reduce adverse cardiovascular events following ACS. But this is the first study to associate the drug with reductions in LAPV, the authors note.

“Additional large, randomized clinical trials are required to evaluate whether low-dose colchicine therapy results in lower rates of future adverse cardiovascular events,” Vaidya et al. wrote.