Could a common anti-inflammatory and a painkiller fight heart disease?

People with Type 2 diabetes are far more likely to suffer cardiovascular events such as stroke and heart attack than the rest of the population, however a new Curtin University project will explore if common, easily accessible medications can reduce this risk.

Researchers will investigate whether anti-gout medication colchicine and/or non-enteric coated aspirin can lower the instances of cardiovascular events in people with Type 2 diabetes who have no clinically evident cardiovascular disease (CVD).

The team, led by John Curtin Distinguished Professor Christopher Reid from the Curtin School of Population Health, will use a $2.84 million Medical Research Future Fund 2023 International Clinical Trial Collaborations grant to conduct a long-term trial, called COLCOT-T2D, to test the drugs’ effectiveness and safety.

The trial is a collaboration with Dr Jean-Claude Tardif from the Montreal Heart Institute, Canada.

A large portion of the 1000 trial participants will come from regional and rural Australia, which Professor Reid said was important because people in these areas face significant health challenges compared to city dwellers.

“The further a person lives from a metropolitan centre, the greater their risk of hospitalisation and death from CVD,” Professor Reid said.

“Despite this, there is evidence that CVD medications and interventions are prescribed less frequently in rural and remote areas compared with metropolitan areas.

“It’s clear patients in these regions would benefit significantly from a low cost, easily accessible treatment to lower the burden of disease.”

The study will explore the benefits of the powerful anti-inflammatory gout medication, colchicine for people with Type 2 diabetes.

Inflammation has long been thought to play a key role in cardiovascular health, with recent studies identifying that anti-inflammatory medications such as colchicine could play a role in reducing incidents associated with CVD.

Professor Reid said using colchicine for CVD prevention had advantages over many other anti-inflammatories.

“For example, studies have shown injections of the anti-inflammatory antibody canakinumab reduce the rate of CVD events, however this requires regular injections, is extremely expensive, and has been shown to be associated with a slightly increased risk of fatal infections,” he said.

“In contrast, colchicine is an inexpensive, well-tolerated, generic medication which can be taken orally.”

This study will explore the use of colchicine with or without aspirin. 

Aspirin is already used to prevent blood clots in people with CVD, however there is conflicting advice over its use in people with Type 2 diabetes.

“Major previous studies have used a once-daily dose of aspirin which is coated to protect the stomach, however this method does not maximise aspirin’s full potential in people with Type 2 diabetes,” Professor Reid said.

“More than half of people with Type 2 diabetes in these studies didn’t respond well to coated aspirin, but results improved dramatically when plain, non-coated aspirin was used.”

Professor Reid said the upcoming study would build on existing research by having participants take colchicine and/or non-coated aspirin twice per day, which other studies have suggested may overcome the resistance to aspirin’s effect experienced by people with diabetes.

“Our study will investigate if colchicine and aspirin, whether taken individually or together, can help improve the long-term cardiovascular health of millions of people living with diabetes across the world, including those particularly vulnerable patients in Australia’s regional and remote areas.”