Reducing Inflammation Reduces Recurrent Heart Attack Risk

Treatment with anti-inflammatory drugs after experiencing a heart attack may reduce the risk of another cardiovascular event, according to a study published by the New England Journal of Medicine.

Despite treatment with cholesterol-lowering drugs, approximately 25% of patients will experience a recurrent heart attack, highlighting the need for a more effective approach.

The findings from the 25-year clinical trial showed a significant drop in recurrent heart attacks, strokes, and cardiovascular death among patients treated with an anti-inflammatory drug that did not modulate cholesterol levels.

“These findings represent the end game of more than 2 decades of research, stemming from a critical observation: Half of heart attacks occur in people who do not have high cholesterol,” said researcher Paul Ridker. “For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk. This has far-reaching implications. It tells us that by leveraging an entirely new way to treat patients—targeting inflammation—we may be able to significantly improve outcomes for certain very high-risk populations.”

Included in the study were more than 10,000 patients who had previously experienced a heart attack and had elevated levels of high-sensitivity C-reactive protein, an inflammatory marker.

All patients received treatment with statins under standard care and were randomized to receive canakinumab or a placebo every 3 months.

Canakinumab is a human monoclonal antibody that neutralizes interleukin- 1β, which can increase inflammation if overexpressed.

The authors found that patients who were treated with 150-mg or 300-mg of canakinumab had a 15% decrease in the risk of another cardiovascular event, according to the study. There was also a 17% reduction in hospitalization for unstable angina that required surgery.

Notably, the need for bypass surgery or angioplasty dropped by 30%, a reduction that was significantly higher than what is observed with statins alone, according to the study.

The investigators found canakinumab to be safe in the study population. While they did observe a small increase in fatal infection, cancer deaths were cut by 50%, leading to a nonsignificant reduction in all-cause mortality, according to the study.

“The results not only establish the role of innate immunity in human atherosclerosis and make actionable decades of research, but they also usher in a new era of therapeutics,” said researcher Peter Libby, MD.

The authors hope to further their study to include patients with sudden plaque ruptures and to determine which drugs may impact inflammatory pathways, according to the study.

“These clinical trial results build upon decades of basic and translational science that has provided mechanistic insights into the key role that inflammation plays in clinical events such as heart attacks and strokes,” said Gary Gibbons, director of the National Heart, Lung, and Blood Institute. “Although this trial provides compelling evidence that targeting inflammation has efficacy in preventing recurrent cardiovascular events, we look forward to findings from additional trials to further refine the best therapeutic strategies for preventing cardiovascular disease.”