Mo Al-Khalaf, Guest contributor
Cardiovascular disease is the second leading cause of death among Canadians and is the number one cause of mortality globally. All indicators point to an increase in the prevalence and severity of heart diseases in the coming decades, including ischemic heart disease, hypertensive heart disease, cardiac arrhythmias, and stroke. As the average human lifespan increases, risk factors have a greater chance of accumulating in the general population. The most common risk factors are things people can do something about: high blood pressure, high blood cholesterol levels, obesity, lack of exercise, elevated stress, and smoking.
Higher incidents of heart diseases take an immense toll on the healthcare system. It not only creates more work for an overburdened healthcare workforce, but produces a financial strain on governments’ and individuals’ healthcare budgets. The Canadian Heart and Stroke Foundation puts the costs related to cardiovascular disease in Canada at approximately Cdn$21 billion a year. The reality is that despite our gains in healthcare knowledge, the need for additional tools and treatment options remains as necessary as it has ever been.
The recent spike in positive results from cardiac therapy clinical trials provides indications that new treatment options are at hand. One such study is the Canadian-based COLCOT trial sponsored by the Montreal Heart Institute and led by Dr. Jean-Claude Tardif. The trial proved that the use of the drug colchicine, along with standard medical therapy, including Aspirin, other antiplatelet agents, statins, or beta-blockers, reduced the rates of ischemic cardiovascular events (resuscitated cardiac arrest, non-fatal heart attack, stroke, or angina) requiring immediate medical assistance and/or hospitalization by about 35 per cent. This therapy is especially promising because colchicine is not a new or expensive drug.
Colchicine was first isolated in the 19th century, and approved for medical use by the United States Federal Drug Administration in the 1960s. The drug lowers the patient’s white blood cell count by interfering with cytoskeleton proteins that assist in cell multiplication which disrupts mitosis (cell division). As such, it is prescribed as an effective anti-inflammatory agent and used to treat immune cell-based diseases like gout, Behcet’s disease, and other inflammatory illnesses.
Results from the COLCOT trial indicate that this safe, affordable drug can be used to benefit patients who have suffered a recent heart attack by targeting the inflammation associated with the acute post-heart attack phase. This research complements the work done at the University of Ottawa Heart Institute by Dr. Peter Liu that describes the extensive role of inflammation in heart disease. Additionally, there are currently three ongoing Phase 3 trials (LoDoC2, CLEAR SYNERGY, and CONVINCE) looking at colchicine in other cardiovascular disease contexts. The evaluation of the clinical use of this drug will be based on these studies’ outcomes.
Another major clinical trial called DAPA-HF showed that the use of a decade-old drug, dapagliflozin, produced a significant reduction in worsening heart failure events, death caused by cardiovascular disease, and the symptoms of patients suffering heart failure pathology. The trial reports an approximate 25 per cent reduction in the number of negative outcomes (defined as death or worsening heart failure) for patients taking dapagliflozin as compared to a placebo.
Illustration by M. Al-Khalaf, PhD
Dapagliflozin is a well-studied SGLT2i (sodium-glucose transporter 2 inhibitor), and is safe and widely used in medical settings. This class of drugs acts in the kidneys to lower blood sugar levels and is commonly used by people with Type-2 diabetes. More recently, it has been shown to interact with cellular components found in the heart and blood circulatory system in a way that is beneficial to maintaining normal blood pressure and heart function.
DAPA-HF provided comprehensive positive evidence for the clinical use of these drugs in heart failure management. As a consequence, the Canadian Cardiovascular Society/Canadian Heart Failure Society has just updated its guidelines to include the SGLT2i class of drugs in heart failure management. SGLT2i drugs can now be used to treat a broader range of people and conditions – young and older patients suffering from moderate to advanced forms of the disease. This means our present “triple therapy” options (angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone antagonists) is now enhanced. This is encouraging news for heart failure patients as any new treatment option that provides symptom relief and potential improvement in daily function is a cause for celebration.
There are other reasons to be excited about the future of heart failure healthcare programs. A couple of major trials are scheduled for completion in 2020. They could provide us with even more tools for treating heart disease, making everyone in our field more optimistic than ever. As cardiovascular disease becomes more prevalent and difficult to manage with our present medical resources, it is encouraging that new (and old!) treatments are emerging as potential tools to improve the lives of people living with heart disease.
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Banner image from pixbay.com)
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