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Category: CVD Prevention

Colchicine Administration in Patients with Chronic Coronary Disease 

Although the anti-inflammatory agent colchicine is currently approved to treat gout attacks and familial Mediterranean fever, when taken regularly in a long-term setting it may have other positive health effects. Research has shown that the compound may prevent conditions caused by inflammation, including several cardiometabolic diseases, however, evidence of its efficacy in risk reduction in patients with chronic coronary disease remains limited.

Results from a new trial reveal that the anti-inflammatory effects of colchicine may be able to reduce the risk of cardiovascular events in patients with recent myocardial infarction. Published in the New England Journal of Medicine, the study evaluated the potential for the medication to reduce the risk of adverse cardiovascular events in patients with chronic coronary disease.

Chronic Coronary Disease and Colchicine  

Led by Stefan M. Nidorf, MD, FACC, a team of researchers conducted a randomized, controlled, double-blind study in which patients with chronic coronary disease were either assigned 0.5 mg of colchicine to be taken once daily or a placebo medication. The primary outcome of their research was the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. The secondary end point measured was the composite of cardiovascular death, spontaneous myocardial infarction, or ischemic stroke.

Risk Reduction of Adverse CV Events

Of the total 5,522 study participants enrolled, 2,762 were assigned to the colchicine cohort while the remainder was given placebo medication. The median duration of follow-up was 28.6 months. At the end of the trial, the primary outcome event occurred in 187 participants or 6.8% in the colchicine group and in 264 patients (9.6%) in the placebo cohort.  In addition, a key secondary end-point was reported in 115 patients (4.2%) within the colchicine group and in 157 patients (5.7%) in the placebo cohort.

The incidence of spontaneous myocardial infarction, ischemia-driven coronary revascularization, and cardiovascular death were all significantly lower in the group treated with colchicine. Unexpectedly, the incidence of death from non-cardiovascular causes was higher in colchicine group than in the placebo group.

Dr. Nidorf and colleagues noted the study’s limitations, which included a lower-than-expected percentage of female participants and a lack of baseline data collection on blood pressure, lipid levels, or inflammatory state that would have allowed researchers to report outcomes based on risk-factor control.

The latest findings are consistent with those of previous trials, indicating that the risk of cardiovascular events could be significantly lowered with the administration of low-dose colchicine once daily. This supports the potential benefits of anti-inflammatory therapies in patients with coronary disease, however, the unexpected rise in non-cardiac deaths is a concern that requires further investigation to assess the risk-to-benefit ratio of using colchicine in this demographic.

Exposure to Long Working Hours May Increase IHD Risk

As the leading cause of death and disability across the globe, ischemic heart disease is a chief driver of disease burden worldwide. Continuous research efforts have been working to identify risk factors, confounding variables, and other disease characteristics that can impact both patient risk and health outcomes.

Increasing evidence points to the significance of the workplace environment as a potential setting for cardiometabolic health improvement and prevention techniques. More specifically, research has linked long working hours (LWH) to increased risk of ischemic heart diseases (IHD) however, study findings have been mixed and have not examined the impact of exposure duration.

A recent study published in the Journal of the American Heart Association aimed to investigate the associations between cumulative exposure to long working hours and the incidence of ischemic heart disease.

Cumulative Exposure to Long Working Hours

As part of the retrospective study, the team of investigators analyzed participants of the French population-based cohort study CONSTANCES. Data from part-time employees and subjects who reported cardiac events in the 5 years before exposure were not included. Researchers administered self-assessments and clinical examinations to obtain subjects’ age, sex, body mass index, occupational status, smoking habits, blood pressure, diabetes status, familial history of cardiovascular disease, dyslipidemia, exposure to long working hours, and duration of exposure. Long working hours were defined as values above 10 hours per day for a minimum of 50 days per year; the main outcome was a reported history of ischemic heart disease, myocardial infarction, or angina pectoris during clinical examinations.

Out of 137,854 participants, nearly 70,000 were males. In total, there were 1,875 (1.36%) reported cases of IHD; exposure to LWH occurred at a rate of 30.8%. Among this group, 14,474 or 10.5% reported exposure for a duration of at least 10 years.

LWH Associated with Increased IHD Risk in Men

The researchers reported that exposure to LWH greater than 10 years was significantly associated with an increased risk of ischemic heart disease; the results were even stronger after the exclusion of patients with angina pectoris. However, in stratified analyses, the results did not persist in the women, regardless of angina pectoris. Interestingly, study findings reveal that increased IHD risk was similar without adjusting for diabetes and blood pressure levels.

Explaining the observed differences, researchers suggest a lack of statistical power given low incidence of IHD among women and the exclusion of part-time employees (primarily women) from the sample. “The observed sex differences in our study and others are worth future exploration to examine other potential explanations including differently gendered work and sex-specific worker survivor effects, changes in work trajectory attributable to child-rearing, diagnostic biases and other cultural and biological differences,” Marc Fadel, MD, of the French National Institute of Health and Medical Research, and colleagues noted .

The latest evidence from the population-based study indicates that cumulative exposure to long working hours has a detrimental effect on cardiometabolic health, especially in the case of increased IHD risk in men. As such, future research efforts should not only explore the underlying causes of differences in IHD incidence between sexes, but also investigate potential preventative strategies aimed at reducing both the exposure and duration of long working hours to improve cardiovascular health outcomes.

“Intervention and implementation research should address the reduction of cumulative exposure to long working hours as a step toward attenuating the global burden of work-related ischemic heart disease,” the authors wrote.