Clinical Resources

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the United States.¹ Patients with ASCVD may be at high risk for acute cardiovascular events regardless of lifestyle changes and reduction of risk factors.

Both inflammation and high cholesterol have been shown to contribute to cardiovascular risk.^2,3 Statin therapy has been shown to be effective in lowering low-density lipoprotein cholesterol (LDL-C) to reduce the risk of cardiovascular events,⁴ but many patients will continue to suffer from life-threatening cardiovascular events due to residual inflammation.⁵

Inflammation plays a significant role in the formation of plaque and is associated with an increased incidence of premature CAD.² Inflammation driven by signaling cytokines, circulating immune cells, adhesion molecules, and oxidized LDL-C leads to atherosclerotic plaque development, plaque progression, and eventual rupture.⁶ Recently, residual inflammatory risk has been shown to be significantly associated with future cardiovascular events.⁷

The addition of an anti-inflammatory medication can help those living with atherosclerosis and residual inflammatory risk to prevent further cardiovascular or coronary complications.⁸

Colchicine, an anti-inflammatory, has been shown to suppress local cardiac production of inflammatory cytokines IL-1β, IL18, and IL-6 in patients with coronary artery disease (CAD). Consistent with these findings, colchicine may significantly inhibit the infiltration of neutrophils and macrophages, and may attenuate the mRNA expression of pro-inflammatory cytokines and NLRP3 inflammasome components in the infarcted myocardium.^9,10

Scientific Publications:

• From CANTOS to CIRT to COLCOT to Clinic: Will All Atherosclerosis Patients Soon Be Treated With Combination Lipid-Lowering and Inflammation-Inhibiting Agents? by Paul M. Ridker (Originally published: 9 Mar 2020)
• Residual Inflammatory Risk: Addressing the Obverse Side of the Atherosclerosis Prevention Coin by Paul M. Ridker (Originally published in the European Heart Journal: 7 June 2016)

1. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
2. Christodoulidis G, Vittorio TJ, Fudim M, Lerakis S, Kosmas CE. Inflammation in coronary artery disease. Cardiol Rev. 2014;22(6):279-288. doi:10.1097/CRD.0000000000000006
3. Sampson UK, Fazio S, Linton MF. Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges. Curr Atheroscler Rep. 2012;14(1):1-10. doi:10.1007/s11883-011-0219-7
4. Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581-590. doi:10.1016/S0140-6736(12)60367-5
5. Ridker PM. Residual inflammatory risk: addressing the obverse side of the atherosclerosis prevention coin. Eur Heart J. 2016;37(22):1720-1722. doi:10.1093/eurheartj/ehw024
6. Ridker PM. 2023. Anti-inflammatory therapy for cardiovascular disease. In: BALLANTYNE-9780323882866. Chapter: 24. PRE-PRINT.
7. Ridker PM, Bhatt DL, Pradhan AD, et al. Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials [published online ahead of print, 2023 Mar 3]. Lancet. 2023;S0140-6736(23)00215-5. doi:10.1016/S0140-6736(23)00215-5
8. Soehnlein O, Libby P. Targeting inflammation in atherosclerosis – from experimental insights to the clinic. Nat Rev Drug Discov. 2021;20(8):589-610. doi:10.1038/s41573-021-00198-1
9. Leung YY, Yao Hui LL, Kraus VB. Colchicine–Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015;45(3):341-350. doi:10.1016/j.semarthrit.2015.06.013
10. Zhang FS, He QZ, Qin CH, Little PJ, Weng JP, Xu SW. Therapeutic potential of colchicine in cardiovascular medicine: a pharmacological review. Acta Pharmacologica Sinica. 2022 Sep;43(9):2173-90.