Colchicine in ischemic heart disease: the good, the bad and the ugly.
Colchicine in ischemic heart disease: the good, the bad and the ugly.
复制标题
DOI：
10.1007/s00392-021-01828-9
复制
发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Crea F
中科院分区：
文献类型：
--
作者：
D'Amario D;Cappetta D;Cappannoli L;Princi G;Migliaro S;Diana G;Chouchane K;Borovac JA;Restivo A;Arcudi A;De Angelis A;Vergallo R;Montone RA;Galli M;Liuzzo G;Crea F
在冠状动脉疾病(CAD)的发展过程中，炎症是参与动脉粥样硬化斑块形成、进展、不稳定和愈合的主要病理生理过程。秋水仙碱是一种在非缺血性心血管疾病和/或全身炎症条件下使用了数十年的药物，它的使用激发了人们对其在冠心病患者中潜在应用的新视角。以往的机制和临床前研究表明，秋水仙碱的抗炎和免疫调节作用是通过其抑制微管聚合的主要机制实现的，但也观察到了其他有益于CV系统的多效性作用，如抑制血小板聚集和抑制血管内皮细胞增殖。在告知我们临床实践的随机双盲临床试验中，小剂量秋水仙碱与稳定性冠心病和慢性冠脉综合征(CCS)患者的心血管事件显著减少有关，而在最近发生急性冠脉综合征(ACS)的患者中，早期开始秋水仙碱治疗显著减少了主要不良心血管事件(MACE)。另一方面，秋水仙碱的安全性及其与观察到的非心血管死亡增加的潜在因果关系值得进一步调查。因此，由于秋水仙碱的潜在毒性，以及目前尚未解决的与非心血管死亡有关的伤害信号，应始终采用精确医学的假设和针对秋水仙素治疗的利弊的患者定制方法。这篇综述的主要目的是对目前关于秋水仙碱在CAD环境中使用的现有证据提供一个平衡、关键和全面的评估。
Inflammation is the main pathophysiological process involved in atherosclerotic plaque formation, progression, instability, and healing during the evolution of coronary artery disease (CAD). The use of colchicine, a drug used for decades in non-ischemic cardiovascular (CV) diseases and/or systemic inflammatory conditions, stimulated new perspectives on its potential application in patients with CAD. Previous mechanistic and preclinical studies revealed anti-inflammatory and immunomodulatory effects of colchicine exerted through its principal mechanism of microtubule polymerization inhibition, however, other pleiotropic effects beneficial to the CV system were observed such as inhibition of platelet aggregation and suppression of endothelial proliferation. In randomized double-blinded clinical trials informing our clinical practice, low doses of colchicine were associated with the significant reduction of cardiovascular events in patients with stable CAD and chronic coronary syndrome (CCS) while in patients with a recent acute coronary syndrome (ACS), early initiation of colchicine treatment significantly reduced major adverse CV events (MACE). On the other hand, the safety profile of colchicine and its potential causal relationship to the observed increase in non-CV deaths warrants further investigation. For these reasons, postulates of precision medicine and patient-tailored approach with regards to benefits and harms of colchicine treatment should be employed at all times due to potential toxicity of colchicine as well as the currently unresolved signal of harm concerning non-CV mortality. The main goal of this review is to provide a balanced, critical, and comprehensive evaluation of currently available evidence with respect to colchicine use in the setting of CAD.
登录
查看更多内容
影响因子：
24
作者：
Flego D;Liuzzo G;Weyand CM;Crea F
通讯作者：
Crea F
DOI：
10.1073/pnas.83.7.2052
发表时间：
1986-04-01
影响因子：
11.1
作者：
BHATTACHARYYA, B;HOWARD, R;WOLFF, J
通讯作者：
WOLFF, J
DOI：
10.1073/pnas.79.22.6753
发表时间：
1982-01-01
期刊：
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA-BIOLOGICAL SCIENCES
影响因子：
--
作者：
ANDREU, JM;TIMASHEFF, SN
通讯作者：
TIMASHEFF, SN
影响因子：
4.7
作者：
Khanna, Dinesh;Khanna, Puja P.;Fitzgerald, John D.;Singh, Manjit K.;Bae, Sangmee;Neogi, Tuhina;Pillinger, Michael H.;Merill, Joan;Lee, Susan;Prakash, Shraddha;Kaldas, Marian;Gogia, Maneesh;Perez-Ruiz, Fernando;Taylor, Will;Liote, Frederic;Choi, Hyon;Singh, Jasvinder A.;Dalbeth, Nicola;Kaplan, Sanford;Niyyar, Vandana;Jones, Danielle;Yarows, Steven A.;Roessler, Blake;Kerr, Gail;King, Charles;Levy, Gerald;Furst, Daniel E.;Edwards, N. Lawrence;Mandell, Brian;Schumacher, H. Ralph;Robbins, Mark;Wenger, Neil;Terkeltaub, Robert
通讯作者：
Terkeltaub, Robert
影响因子：
37.8
作者：
Deftereos, Spyridon;Giannopoulos, Georgios;Lekakis, John
通讯作者：
Lekakis, John