CCTA shows colchicine's impact on atherosclerosis progression
The anti-inflammatory medication colchicine can help reduce coronary soft plaques as seen on on coronary computed tomography angiography (CCTA), according to the late-breaking EKSTROM trial first presented at ACC.25.
“We did serial CT angiography baseline and one-year follow-up after randomizing patients to 0.5 mg of colchicine daily or placebo. We saw over a 1% reduction in percent atheroma volume in the colchicine group, which mirrors the degree of improvement associated with significant reductions in major adverse cardiovascular events in prior intravascular ultrasound studies,” Matthew J. Budoff, MD, former president of the Society of Cardiovascular Computed Tomography (SCCT) and a professor of medicine with the David Geffen School of Medicine at UCLA, told Cardiovascular Business.
Although it was a small study of just 80 participants, it offers compelling evidence that low-dose colchicine can significantly reduce plaque burden in patients with stable coronary disease over just one year. Budoff said it builds on findings from landmark studies such as LoDoCo2 and COLCOT, further reinforcing colchicine’s role in managing coronary inflammation and plaque buildup.
Notably, the imaging results indicated trends toward regression of various plaque types and a significant slowing in the progression of calcified plaque.
"Not only did it lower inflammation and have a significant reduction in CRP, it actually lowered plaque burden. We saw trends towards regression of noncalcified plaque, fibro-fatty plaque and fibrous plaque, and a significant slowing of calcified plaque under the influence of colchicine. And that was just one year. It was a relatively small study, but I think it does support the use of colchicine in chronic stable coronary disease patients," Budoff said.
CCTA offers advantages to visualizing coronary disease
CCTA, a non-invasive imaging modality that offers a detailed visualization of coronary plaque composition, was central to this evaluation. The team used a semi-automated software platform from Medis to quantify plaque burden, a system previously validated in several major trials. However, Budoff noted that AI-driven software is rapidly advancing when it comes to plaque quantification and may soon make such assessments routine in clinical practice. He said this adds clinical value and enables personalizing care to specific patients, rather than guessing at a patient's risk using population-based risk scores without actually knowing what level of disease, if any, exists in a patient's arteries.
"I do think that we're going to see a lot more screening CCTA. I think that calcium scoring is already going pretty mainstream, and it's getting more and more common. But for younger patients, for patients with maybe discordant results where they have a lot of risk factors and the calcium score is zero, or patients who want to get a better look at plaque and plaque burden and maybe coronary inflammation, CCTA will offer a lot more than a calcium score," Budoff explained.
He sees this study as another step toward personalized cardiovascular care CCTA helps cardiologists track atherosclerosis progression or regression noninvasively. He said that opens the door to adjusting treatment based on actual plaque behavior, not just surrogate markers like LDL or low dose-CT calcium scoring.
He also highlighted the potential of newer AI technologies like pericoronary fat attenuation index (FAI) to assess vessel inflammation directly via CCTA. He said this technology, currently cleared for use in Europe and pending U.S. FDA review, will be ideal for selecting which patients actually have coronary inflammation and should have colchicine added to their preventive drug therapy.
“It's going to be a very nice adjunctive tool. It shows the cellular inflammation around the coronary arteries, and we know that there's a very tight correlation between inflammation in the fat beds around the heart and coronary events. There’s a tight link between inflammation in the fat surrounding the heart and cardiovascular events," Budoff explained.
CCTA scans require a contrast injection and are more involved than the current CT calcium scoring exams, but add much more diagnostic value. He said calcium is basically scar tissue in the coronary arteries showing where there was previously inflamed plaques that damaged the vessels and healed. But they only tell part of the story.
"Patients who have a lot of scar tissue have a lot of injuries, and therefore we know they have a lot of atherosclerosis. So I still think calcium is the tip of the iceberg for atherosclerotic burden. But seeing the pericoronary fat attenuation, seeing the soft plaque, quantifying the soft plaque and seeing stenosis, will all going to add a lot of value to CCTA over coronary calcium," Budoff said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]