Dr. Tardif Jean-Claude Tardif CM, MD, FRCPC, FCCS, FACC, FAHA, FESC, FCAHS Director, Montrel Heart Institute Research Center Professor of medicine Canada Research Chair in translational and personalized medicine University of Montreal endowed research chair in atherosclerosis Montreal Heart Institute MedicalResearch.com: What is the background for this study? Response: Inflammation appears to play an important role in atherosclerosis. Inhibition of interleukin-1ß by canakinumab reduced the rate of cardiovascular events by 15% CANTOS. In contrast, methotrexate did not affect cardiovascular outcomes or plasma markers of inflammation in CIRT. Colchicine is an inexpensive, orally administered, potent anti-inflammatory medication that has been used for centuries. Colchicine is currently indicated for the management of patients with gout, familial Mediterranean fever and pericarditis. In the LODOCO study, patients with stable coronary disease treated with colchicine 0.5 mg once daily experienced fewer cardiovascular events as compared with those not receiving colchicine. However, that study enrolled only 532 patients and was not placebo-controlled. Because acute coronary syndromes are associated with higher risks of recurrent events and exacerbated inflammation, we conducted the COLchicine Cardiovascular Outcomes Trial (COLCOT) in patients with a recent myocardial infarction to evaluate the effects of colchicine on cardiovascular outcomes and its long-term safety and tolerability. MedicalResearch.com: What are the main findings?  Response: COLCOT was a double-blind, placebo-controlled, randomized clinical trial of 4745 patients recruited within 30 days after myocardial infarction. Patients were treated according to national guidelines (99% aspirin, 98% a second anti-platelet agent, 99% statin, 93% PCI) and randomly assigned to receive colchicine 0.5 mg daily or placebo.  Median follow-up was 22.6 months. Colchicine reduced the risk of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke or urgent hospitalization for angina requiring coronary revascularization by 23% compared to placebo (p=0.02). The rate of total (first and recurrent) primary endpoint events was reduced by 34% with colchicine (rate ratio vs. placebo, 0.66; 95% CI, 0.51 to 0.86). Colchicine was well tolerated. A nominally higher incidence of diarrhea occurred with colchicine than placebo (9.7% versus 8.9%, p=0.35). Pneumonia was reported as a serious adverse event in 0.9% and 0.4% of patients in the colchicine and placebo groups, respectively (p=0.03).  MedicalResearch.com: What should readers take away from your report? Response: Colchicine at the low dose of 0.5 mg daily led to a significantly lower rate of ischemic cardiovascular events than placebo among patients with a recent myocardial infarction.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: The COLCOT results apply to patients who have recently suffered a myocardial infarction. Further research is needed to assess the benefits of colchicine in other high-risk patients. The LODOCO2 trial of patients with stable coronary disease will be reported in September 2020. We will be launching early in 2020 the COLCOT-T2D trial of 10,000 patients with type 2 diabetes but without known coronary disease.  Citation: Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction Jean-Claude Tardif, M.D., Simon Kouz, M.D., David D. Waters, M.D., Olivier F. Bertrand, M.D., Ph.D., Rafael Diaz, M.D., Aldo P. Maggioni, M.D., Fausto J. Pinto, M.D., Ph.D., Reda Ibrahim, M.D., Habib Gamra, M.D., Ghassan S. Kiwan, M.D., Colin Berry, M.D., Ph.D., José López-Sendón, M.D., et al N Engl J Med 2019; 381:2497-2505 DOI: 10.1056/NEJMoa1912388 Last Modified:   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

MedicalResearch.com Interview with: Dr. David Berg Dr. David Berg MD Senior Fellow in Cardiovascular Medicine and Critical Care Medicine Brigham and Women’s Hospital Postdoctoral Research Fellow with the TIMI Study Group. MedicalResearch.com: What is the background for this study? Response: Heart failure is a frequent and important complication of type 2 diabetes mellitus (T2DM), but there are limited tools for identifying which patients with T2DM are at the highest risk of developing heart failure. In this study, we developed and validated the TIMI Risk Score for Heart Failure in Diabetes , a novel clinical risk score that identifies patients with T2DM who are at heightened risk for hospitalization due to heart failure. Fortunately, the risk score also identifies patients who have the greatest absolute reduction in the risk of hospitalization for heart failure with a new class of glucose-lowering therapies called sodium-glucose cotransporter-2 (SGLT2) inhibitors.  MedicalResearch.com: What should readers take away from your report? Response: The components of the risk score highlight the fact that underlying heart and kidney problems are key drivers of the risk for heart failure hospitalization in patients with type 2 diabetes mellitus. Our study also confirms that SGLT2 inhibitors reduce the relative risk of hospitalization for heart failure in all patients with type 2 diabetes mellitus; however, by using TRS-HF(DM), clinicians can better educate patients about their risk for heart failure hospitalization and identify those patients who have the greatest absolute reduction in risk of hospitalization for heart failure with SGLT2 inhibitors. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: There is still much more to learn about what drives heart failure risk in patients with T2DM. In future studies, for example, it will be important to consider whether blood biomarkers and genetic information can provide additional insights into which patients with type 2 diabetes mellitus are at heightened risk for heart failure. MedicalResearch.com: Is there anything else you would like to add? Response: I have no personal disclosures. The databases used to conduct the study were taken from trials funded by AstraZeneca. Citation: Heart Failure Risk Stratification and Efficacy of SGLT2 Inhibitors in Patients with Type 2 Diabetes Mellitus   https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/The-right-glucose-lowering-drugs-for-the-right-patient/195652-heart-failure-risk-stratification-and-efficacy-of-dapagliflozin-in-patients-with-type-2-diabetes-mellitus ESC Congress 2019   Last Modified:       The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

MedicalResearch.com Interview with: Prof. Danchin Nicolas Danchin MD, FESC Professor of Medicine, Consultant Cardiologist Intensive Cardiac Care Unit Hôpital Européen Georges Pompidou Paris, France MedicalResearch.com: What is the background for this study? Response: FAST-MI is a programme of nationwide French surveys, carried out every 5 years in France since 2005 in patients hospitalised with STEMI or NSTEMI. Patients are included consecutively for one month and 10-year follow-up is organized. We can thus analyse patients' outcomes in relation with their profile. Knowing that diabetic patients represent a large proportion of patients with AMI, we thought it would be worthwhile determining whether they suffered specific complications, and in particular, heart failure, both at the acute stage and in the subsequent months. MedicalResearch.com: What are the main findings? Response: We found that diabetic patients were at increased risk of developing heart failure at the acute stage, (29% versus 15% in non-diabetic patients, adjusted hazard ratio 1.64, P Read the full article