Counter-revolution in cardiology. There was a drug for the prevention of heart attacks | Healthy life | Health

In the USA, a means for the prevention of heart attacks with a fundamentally new mechanism of action goes on sale. But the drug itself is very old. Recently, the US Food and Drug Administration (FDA) officially approved it for the treatment of heart problems.

In a sense, this is a counter-revolution against statins. Registration of a drug with such a mechanism of action de facto shows that the role of cholesterol in the development of heart attacks and strokes is no longer the main one, and statins are not the main drugs for their prevention.

Upstart among medicines

Why is that? talks about this biologist, professor at the School of Systems Biology at George Mason University (USA) and well-known medical blogger Ancha Baranova.

“Colchicine as a drug is a hundred years old. It’s a drug, how to put it nicely… pre-pharmaceutical. From folk, that is, medicine. Autumn colchicum extract (Colchicum autumnale L.). They treat gout, arthritis, and other inflammatory phenomena.

And now, with the blessing of the FDA, colchicine burst into the “big” world of evidence-based medicine as a drug LoDoCo (Lodoko). This “crible-crable-booms” stands for Low Dose Colchicine (500 micrograms of low-dose colchicine). It has been used in medicine before (by prescription) – for example, for Behçet’s disease. But recently there was a breakthrough – it was clearly shown that low-dose colchicine copes well with the consequences of recent heart attacks, and also helps prevent vascular thrombosis due to “unstable” atherosclerotic plaques.

And all because colchicine copes well with inflammation. The thing is that the cholesterol component of plaques is not the main thing. Even if it is difficult to drive cholesterol back to normal, people with coronary heart disease still have an above-average risk of heart attacks and sudden death. And all because of inflammation.

Cardiologists have known this for a long time, but no anti-inflammatory drug was approved by the FDA for the treatment of atherosclerosis until last month. And then Lodoko appeared.

Why is inflammation more important than cholesterol?

Many mechanisms for the development of a heart attack are presented as follows: cholesterol is deposited in a vessel that carries blood to the heart, and an atherosclerotic plaque “grows” on its basis, over time it blocks the vessel, and this leads to a heart attack. In reality, everything happens differently. Even a small plaque that blocks the lumen of the vessel by only 20-40% can cause a heart attack if inflammation develops in it. The blood clotting system responds to this by forming a clot on the surface of the plaque. It clogs the vessel and causes a heart attack. In 70-80 percent of cases, this formidable condition develops in this way. And to warn him, you need:

– or reduce blood clotting – for this, the cores take cardioaspirin or other drugs that reduce the risk of blood clots.

– or weaken the inflammation in the plaque and the wall of blood vessels. Until recently, there were no drugs for this, and now Lodoko has appeared.

– or better yet, use both of these drugs.

The instructions for the drug say that they take it to “reduce the risk of myocardial infarctions, strokes, coronary revascularization (surgery on the heart vessels due to atherosclerotic plaques – approx. and cardiovascular death in adult patients with established atherosclerosis or with multiple risk factors for cardiovascular disease.

Will they be treated with such a drug in Russia?

Of course, this still does not solve all the problems associated with atherosclerosis. Firstly, as Ancha Baranova explains, while Lodoko is suggested to be taken simultaneously with statins, so that the effect is better. However, it is they that increase the side effects of colchicine. Secondly, colchicine has many contraindications and side effects. And all this limits its use even at a low dose of 500 mcg. For example, it is a mutagen, and geneticists even use colchicine as such in experiments to stimulate mutations. Thirdly, an overdose of the drug is very dangerous, it can be fatal.

Will this medicine reach Russia? In principle, we already have drugs with colchicine, but in large dosages. To establish their production in low doses, of course, is not a problem. The main thing is that doctors become interested in this remedy and begin to prescribe it. Experience shows that this takes some time. But in principle, all this is real.

The main thing is that now pharmaceutical companies will try to create an anti-inflammatory drug with a similar effect, but safer. And such a medicine will become a real pharmaceutical blockbuster. As it happened in due time with statins.


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