The potential of colchicine for lowering the risk of cardiovascular events in type 1 diabetes

• Published in: European heart journal. Cardiovascular pharmacotherapy Vol. 9; no. 4; pp. 311 - 317
• Main Authors: Johansen, Nicklas Järvelä, Knop, Filip Krag
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 02-06-2023
• Subjects: Atherosclerosis; Atherosclerosis - complications; Brain Ischemia - chemically induced; C-reactive protein; Cardiovascular disease; Colchicine; Colchicine - adverse effects; Comparative analysis; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - drug therapy; Diabetes therapy; Health aspects; Heart attack; Humans; Hypertension; Inflammation; Ischemia; Prevention; Risk factors; Stroke - chemically induced; Type 1 diabetes; Type 2 diabetes; Denmark; Cardiovascular disease; Inflammation; Residual inflammatory risk; Colchicine; Type 1 diabetes; Anti-inflammatory
• ISSN: 2055-6837; 2055-6845
• DOI: 10.1093/ehjcvp/pvad005

Abstract
In type 1 diabetes, average life expectancy is reduced by ˃10 years as compared with outside of diabetes. Residual cardiovascular risk defines high cardiovascular event rate despite modern, guideline-recommended standard of care of established risk factors like hypertension, dyslipidaemia, and glycaemic control, and it adds importantly to these lost years of life in type 1 diabetes due to atherosclerotic cardiovascular diseases like myocardial infarction and ischaemic stroke. With a growing understanding of inflammation as an important driver of atherosclerotic cardiovascular disease, residual inflammatory risk is a novel and common risk factor and a promising target for lowering residual cardiovascular risk in type 1 diabetes. Interestingly, the inexpensive anti-inflammatory agent colchicine reduced the risk of major adverse cardiovascular events by 25% in cardiovascular outcome trials in the secondary prevention of atherosclerotic cardiovascular disease. Here, we summarize the role of inflammation as a driver of atherosclerosis and review current evidence linking inflammation and atherosclerotic cardiovascular disease in type 1 diabetes. Also, we provide an overview of the evidence base for targeting residual inflammatory risk with colchicine for lowering residual cardiovascular risk in type 1 diabetes.
Graphical Abstract
Graphical Abstract
ASCVD, atherosclerotic cardiovascular disease; CRP, C-reactive protein; CV, cardiovascular; MACE, major adverse cardiovascular event; T1D, type 1 diabetes.