Anti-inflammatory effects of atorvastatin and colchicine combination in patients with acute or chronic coronary syndrome undergoing coronary angiography and/or PCI
T Trijitwatthanakoon, Apichat Jansillapakorn, Sakolwat MontrivadeAbstract
Background
Despite statin therapy, residual inflammation contributes to cardiovascular events in acute or chronic coronary syndromes (ACS/CCS). While colchicine is a potent anti-inflammatory adjunct, its simultaneous use with high-intensity atorvastatin raises safety concerns regarding rhabdomyolysis. We evaluated the efficacy and safety of this combination on high-sensitivity C-reactive protein (hsCRP) reduction.
Methods
This interim analysis of a double-blind, randomized controlled trial included 60 ACS/CCS patients undergoing angiography or PCI. Patients were randomized (1:1) to atorvastatin 40 mg plus colchicine 0.6 mg daily (n = 31) or atorvastatin 40 mg plus placebo (n = 29). The primary outcome was the change in hsCRP over 3 months.
Results
Baseline geometric mean (GM) hsCRP was comparable between combination and monotherapy groups (2.95 vs. 3.07 mg/L; p = 0.904). At 3 months, GM hsCRP was significantly lower in the combination group (0.93 vs. 1.89 mg/L; p = 0.038), representing a 51% greater reduction (GM ratio 0.49; 95% CI 0.25–0.96). Severe diarrhea was more frequently observed in the colchicine group (16.7% vs. 0%; p=0.053), but there was no rhabdomyolysis or hepatitis reported. Clinical events (MACE) were infrequent and similar between groups (10.0% vs. 7.1%; p = 1.000).
Conclusion
The simultaneous initiation of low-dose colchicine and atorvastatin 40 mg significantly reduced systemic inflammation in ACS/CCS patients. Despite an increased incidence of severe diarrhea, the potent synergistic effect and favorable muscle safety profile support its potential to target residual cardiovascular risk.Figure 1 Geometric mean of hsCRP levelsTable 1 Baseline Characteristics