Therapeutic potential of colchicine in cardiovascular medicine: a pharmacological review
Coronary Artery Disease
Coronary artery disease (CAD; also atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.
CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.
As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.
A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).
What To Know About Carotid Artery Disease
Carotid artery disease is a common cause of stroke. It occurs when plaque builds up inside the carotid arteries. These are the arteries that supply oxygen-rich blood to the brain.
There are two large common carotid arteries, one on each side of the neck. Each of these arteries separates into an external and internal carotid artery leading up to the brain.
Plaque is a combination of fat, calcium, cholesterol, and other substances. Over time, plaque can build up in these arteries in a process called atherosclerosis. Plaque buildups narrow the arteries and make it more difficult for blood to get through them.
A narrowed carotid artery poses a serious risk, as it may reduce or block the blood flow to the brain, which could cause a stroke.
Carotid artery disease is different from coronary artery disease. This is because carotid artery disease reduces the flow of oxygen-rich blood to the brain, while coronary artery disease reduces the flow of oxygen-rich blood to the heart.
Many people with carotid artery disease do not have any symptoms at first. Carotid artery disease generally starts causing noticeable symptoms as the condition gets worse.
Severe narrowing of the artery or a blockage in it may cause serious signs and symptoms, including:
Bruit
A carotid bruit is a sound present in the carotid arteries of some people with carotid artery disease.
During a physical examination, the doctor will place a stethoscope on the neck near the carotid arteries and listen for a slight "whooshing" sound. Bruit may suggest that the person has reduced blood flow through the artery due to atherosclerosis.
Transient ischemic attack
A TIA is very similar to a stroke, but it is not as severe. Both TIAs and strokes occur due to blockages that reduce blood flow to the brain. Some people may refer to it as a mini stroke. However, it still requires immediate medical attention.
Symptoms of both a TIA and stroke include:
Anyone experiencing these symptoms needs urgent medical attention. If a person experiences a TIA, the symptoms generally go away within the first 24 hours.
Stroke
A stroke causes the same symptoms as a TIA, but the results may be more severe. A stroke may lead to permanent brain damage due to loss of oxygen. A stroke may cause permanent vision problems, speech issues, or long-term disability. In some cases, a stroke may lead to paralysis or death.
Anyone who notices signs of a TIA or stroke should seek emergency medical help immediately.
Atherosclerosis, or plaque buildup is the direct cause of carotid artery disease. This buildup results in a narrowing or hardening of the carotid arteries, which slows or blocks blood flow to the brain.
Although the components of plaque exist in the blood itself, they are more likely to gather in microscopic areas of damage in the arteries.
This damage occurs as a result of genetic factors, as well as the effects of diet and lifestyle choices over time. Major contributing risk factors for damage and plaque buildup in the arteries include:
Diagnosing carotid artery disease as early as possible is important to prevent potentially life threatening complications, such as stroke.
A doctor will ask the person about their medical history and lifestyle habits. If the doctor feels that a person may be at risk for carotid artery disease, they may run a physical exam or order other tests to check the person's blood health.
Listening for a bruit is part of a physical exam. If doctors listen to the arteries and hear a bruit, they will order additional tests.
Imaging tests
Doctors generally use one or more imaging tests to see inside the carotid arteries and check for narrowing. Imaging tests include ultrasounds and angiography.
A carotid ultrasound uses sound waves to create images of the inside of the arteries. It is the most common form of imaging test for carotid artery disease, and in most cases, it can help reveal any narrowing of the arteries.
An angiography is an imaging test that uses a special dye to make the arteries show up clearly in the image.
Doctors will inject the dye into the area, then use either X-rays, CT scans, or MRIs to make images of the arteries as the dye passes through them. This test can help doctors see any narrowing or blockages in the artery.
Treatment for carotid artery disease is vital to reduce the risk of life threatening complications and keep the disease from progressing.
Treatment includes making dietary and lifestyle changes. In some cases, a person may need to take medication or undergo a surgical procedure.
Dietary and lifestyle changes
Dietary and lifestyle changes are an essential part of a treatment plan for carotid artery disease. A doctor may recommend:
General diet tips
Instead, the person should focus on a balanced heart-healthy diet, rich in foods such as:
Medications
Doctors may also recommend taking medications to help manage carotid artery disease.
Common medications include drugs to keep the blood from clotting, such as aspirin or clopidogrel. Doctors may recommend additional drugs, such as those that control cholesterol or lower blood pressure, depending on a person's underlying risk factors.
Medical procedures
People who experience symptoms of carotid artery disease or are at risk for major complications may need to have one or more medical procedures to reduce their risk.
Possible procedures include:
Angioplasty and stenting
Angioplasty and stenting can help widen the carotid arteries and increase blood flow to the brain if the person has severe narrowing from plaque.
During an angioplasty procedure, doctors insert a thin tube with a tiny deflated balloon on its end into the narrow artery. With the tube in place, they inflate the balloon, which pushes the plaque out toward the artery wall, helping restore blood flow through the artery.
With the artery expanded, doctors can place a stent — a thin mesh tube — in the area. The stent will help support and strengthen the artery from the inside, and it will keep the artery from narrowing in that area again.
Endarterectomy
Endarterectomy is not as common, and may not be right for everyone. Doctors may recommend it for more severe narrowing or blockages.
During this procedure, the surgeon makes a cut into the neck to reach the narrowed artery. When they find the blockage, they will make a cut in the artery and remove the inner lining in that area. Doing this eliminates the cause of the blockage, which helps restore blood flow.
What is the most common cause of carotid artery disease?
The most common cause of carotid artery disease is atherosclerosis. This describes the buildup of plaque in the arteries.
Can you live a long life with carotid artery disease?
Evidence suggests it is possible to live a long life with carotid artery disease. However, this will depend on several factors, such as a person's age, symptoms, and treatment. For example, it is highly advisable to receive treatment and try to reduce the risk of having a stroke by modifying risk factors, such as increasing levels of physical activity.
What foods should you avoid with carotid artery disease?
Dietary changes can help to manage carotid artery disease. As such, it is advisable to avoid foods high in saturated fats and cholesterol. This can include red meat, processed meat, whole-dairy products, and foods with trans fats such as French fries and doughnuts.
How fast does carotid artery disease progress?
Carotid artery disease often develops slowly. Generally, worsening of the condition will take a few years. However, the progression of the disease can vary between people and it is possible for it to progress rapidly in some individuals.
Carotid artery disease causes narrowing or blockages in the arteries leading to the brain, known as the carotid arteries.
Many health conditions and unhealthful lifestyle choices can increase the risk of plaque buildup and carotid artery disease.
Successful treatment includes making dietary and lifestyle changes to reduce the plaque buildup in the arteries and lower the risk of serious complications, such as stroke. In some cases, a person may require medications or medical procedures.
Anyone who notices signs of a stroke, such as slurred speech or weakness, should seek emergency medical attention.
New Drug Promises More Accurate Diagnosis For Heart Disease
Sept. 30, 2024 – A newly FDA-approved drug will improve the diagnosis of coronary artery disease, the most common type of heart disease, which impacts more than 18 million adults in the U.S. And is the leading cause of death nationwide.
Given as a shot before heart imaging tests, the drug – called flurpiridaz and marketed under the brand name Flyrcado – is a radiotracer, a substance that helps doctors see inside the body during a scan. The approval was made using the agency's priority review process, reserved for drugs that address serious conditions and work significantly better than existing options.
The current standard for examining blood flow through the heart and evaluating suspected coronary artery disease (CAD) is myocardial perfusion imaging with single photon emission computed tomography. It's also known as a nuclear stress test.
With Flyrcado, the test can now be done using a PET scan – known to be better at detecting CAD, but not widely used because of challenges posed by other radiotracers.
"Flyrcado is the most exciting development in the field of nuclear cardiology over the past few decades," Jamshid Maddahi, MD, the lead researcher for the Flyrcado clinical trials and a clinical professor at the UCLA School of Medicine, said in a news release from GE HealthCare, the drug's maker. "I am excited for this new radiotracer and its potential impact, as a game changer, for diagnosing the disease with the highest mortality rate in the world."
While other radiotracers must be produced on-site where the tests happen, Flyrcado can be made off-site and arrive at test locations ready to use. It lasts at least 109 minutes, potentially allowing for more testing in one session as well as time for repeat testing, if needed.
An estimated 6 million people get imaging for suspected CAD each year, according to GE HealthCare. Coronary artery disease is usually caused by a problem called atherosclerosis, which happens when plaque from fat and cholesterol builds up in the arteries and blocks blood flow. People with CAD may have chest pain or shortness of breath, and a complete blockage can cause a heart attack.
Flyrcado's approval is based on the results of two studies, showing the drug helped identify 63% to 89% of those with CAD. One study suggested that the use of Flyrcado with PET myocardial perfusion imaging was particularly effective at detecting disease in women and in people who have obesity.
At least 2% of study participants who took Flyrcado had an adverse reaction such as shortness of breath, headache, chest pain that was sometimes severe, fatigue, flushing, nausea, belly pain, dizziness, and irregular heartbeat.
Flyrcado will be available starting in early 2025, according to GE HealthCare.
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