Worldwide, heart disease is responsible for millions of deaths and, in the US, is the most common cause of death despite ongoing advancements in therapy. Several conditions fall under the umbrella of the term ‘heart disease,’ the most common being coronary artery disease or CAD. If left untreated, CAD can lead to a heart attack that, if non-fatal, can significantly impact a patient’s quality of life. For those high-risk patients with a known history of significant cardiovascular disease, secondary preventive strategies are generally instituted to reduce mortality, improve symptoms, and minimize the risk of recurrent adverse cardiovascular events. Anti-cholesterol medications, for example, are an effective form of secondary prevention. Perhaps less well understood is the impact of anti-inflammatory agents for the treatment of heart disease.
Emerging evidence has demonstrated that the immune system plays a significant role in the progression of heart disease. Following cardiac injury, a robust inflammatory response is produced, resulting in a cascade of cellular events and ultimately, tissue damage. As such, studies have been conducted to evaluate the effectiveness of specific anti-inflammatory agents in the treatment of heart disease. In August 2021, the results of a systematic review and meta-analysis investigating related studies were published. Eighteen randomized controlled trials (RCTs) were selected for review, which included over 67,000 participants in total. Primary outcome measures were recurrent heart attack and stroke, as well as all-cause mortality. Studies utilizing non-steroidal anti-inflammatory medications were excluded.
Although a pooled analysis of RCTs did not demonstrate a statistically significant reduction in primary endpoints with anti-inflammatory medications, subgroup analysis showed that the use of certain anti-inflammatory drugs in patients with stable heart disease reduced the risk of recurrent heart attack and the need for revascularization. Notably, Colchicine which has traditionally been used to treat certain forms of arthritis, demonstrated the most considerable benefit.
Although these results are promising, it should be noted that the review demonstrated limitations such as a small sample size in some studies and a risk of bias in others. Not all participants with heart disease benefited from anti-inflammatory therapy, and studies also showed an increased risk of infection with such treatment. However, despite these limitations, this strong body of evidence suggests that the administration of anti-inflammatory therapy may improve long-term cardiovascular outcomes in those with heart disease and should therefore be considered in select patients following a careful analysis of individual risks and benefits.
Sources: CDC, Nature Reviews, Frontiers in Cardiovascular Medicine