Cardiovascular Prevention and Pharmacotherapy

Review Article

Expectations and concerns regarding medical advertisements via large commercial medical platform advertising companies: a legal perspective: Raeun Kim, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(2):48-56. Published online April 26, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e8; Funded: National IT Industry Promotion Agency, Ministry of Science and ICT

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Abstract PDF: Advertising in the medical and legal fields, which are among Korea's leading professions, has increasingly utilized major advertising platforms such as LawTalk and UNNI—two of the most prominent and contentious platforms in their respective fields. While it is generally unproblematic for professionals like lawyers and doctors to promote public interest through advertising on these commercial platforms, the creation of a profit-driven structure has the potential to undermine their professional ecosystems. This article explores the issues associated with advertising in the medical field through large commercial platforms, drawing on notable examples from the legal and medical fields in Korea. Specifically, we analyze two of the most popular yet controversial platforms in these sectors, LawTalk and UNNI. In Korea, the format and method of advertising are legal as long as they do not involve referring or soliciting clients, thereby making platform advertising lawful when used solely for that purpose. Nevertheless, it is crucial to prevent medical advertising platforms from establishing market monopolies by skirting various profit regulations and laws. In response to these concerns, the Korean Bar Association has prohibited all advertisements by platform companies. The medical community should closely examine the rationale and process behind this decision. Given the significant social influence of large corporate platforms and the unique social responsibilities of the medical and legal professions, future platform advertising should be subject to distinct legal and institutional regulations that differ from those applied to general services.

Original Article

Cardiac rehabilitation using intensive lifestyle habituation combined with outdoor exercise in an urban forest environment for primary and secondary prevention of coronary artery disease: a feasibility test: Jong-Young Lee, Kee-Chan Joo, Kyung-Su Choi, Dae-Sik Yoon; Cardiovasc Prev Pharmacother. 2024;6(2):74-83. Published online April 25, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e10; Funded: Korea Forestry Promotion Institute

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Abstract PDF: Background
We aimed to examine the feasibility of intensive lifestyle habituation with a subsequent home program, including forest-based exercise, as an alternative approach to conventional cardiac rehabilitation for both primary and secondary prevention of coronary artery disease (CAD).
Methods
A total of 28 participants were included in a 1-week intensive education program aimed at fostering desirable lifestyle habits in the study: 17 patients who underwent percutaneous coronary intervention and 11 participants at high risk of CAD. Subsequently, they engaged in a self-directed, home-based program that included unstructured exercise in an urban forest. The terrain of the urban forest was analyzed to estimate metabolic equivalent levels and to assess safety and accessibility for patient exercise.
Results
Throughout the program, no adverse cardiac events were reported. Additionally, risk factors for CAD—including body composition, blood sugar levels, hemodynamic variables, total cholesterol levels, and cardiorespiratory endurance—showed significant improvement in both groups.
Conclusions
Intensive lifestyle habituation and unstructured, self-directed exercise in the forest were as effective and safe as conventional cardiac rehabilitation for patients with CAD. The study demonstrated that an urban forest could serve as a safe exercise environment in both primary and secondary prevention strategies for CAD.

Review Article

Using medical big data for clinical research and legal considerations for the protection of personal information: the double-edged sword: Raeun Kim, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):8-16. Published online January 22, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e1; Funded: National IT Industry Promotion Agency, Ministry of Science, ICT and Future Planning

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Abstract PDF: The advent of medical big data has increased the scope of the clinical use of such data; however, these data have raised serious concerns regarding personal privacy protection, which hinders their usage. For instance, as the pseudonymization or anonymization of data increases, the quality of its clinical use decreases. Thus, a balanced approach is required to maximize clinical data use while protecting personal information as much as possible. However, Korea’s existing laws mandate several kinds of consent; soliciting some of these types of consent can be cumbersome. Moreover, while the collection of medical data by hospitals requires considerable time and money, its ownership is difficult to ascertain. To bridge the enormous gap between the protection of personal information and the use of clinical data, the European Union and countries such as Finland have already proposed various modes of guaranteeing the free movement of personal information that simultaneously strengthen people’s personal rights. Similarly, Korea has initiated the MyData Service, although it faces several limitations. Therefore, this study reviews Korea’s current healthcare big data system, the laws governing data sharing and usage, and compares them with similar laws enacted by the European Union and Finland. It then provides future direction for Korea’s personal information protection legislation. Ultimately, governments must expand and elaborate upon the scope and content of personal information protection laws to enable the development of healthcare and other industries without sacrificing either personal information protection or clinical use of medical data.

Original Article

Current status of remote collaborative care for hypertension in medically underserved areas: Seo Yeon Baik, Kyoung Min Kim, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):33-39. Published online January 22, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e2; Funded: Ministry of Health and Welfare

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Abstract PDF: Background
Remote collaborative care (ReCC) is a legally recognized form of telehealth that facilitates communication between physicians. This study aimed to analyze the effectiveness of ReCC services and establish a foundation for the usefulness and effectiveness of ReCC.
Methods
This retrospective cohort study utilized data from the Digital Healthcare Information System (DHIS) managed by the Korea Social Security Information Service. We extracted data on patients who were registered from January 2017 through September 2023 to investigate the effects of various factors.
Results
A total of 10,407 individuals participated in the remote collaborative consultation service provided by the DHIS. Of these participants, those aged ≥80 years represented 39.2% (4,085 patients), while those aged 70 to 79 years comprised 36.9% (3,838 patients). The conditions treated included hypertension, affecting 69.2% (7,203 patients), and diabetes, affecting 21.1% (2,201 patients). Although various measurement items were recorded, most data beyond blood pressure readings were missing, posing a challenge for analysis. Notably, there was a significant reduction in blood pressure that was sustained at follow-up intervals of 1, 3, 6, and 12 months post-baseline (all P<0.05).
Conclusions
Owing to the lack of data, follow-up assessments for conditions other than hypertension proved to be challenging. Medical staff should increase their focus on and engagement with the system. Remote consultations have demonstrated efficacy in managing hypertension in medically underserved areas, where access to healthcare services is often limited. This suggests the potential for expanded use of remote chronic care in the future.

Review Article

Diverse perspectives on remote collaborative care for chronic disease management: Seo Yeon Baik, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):26-32. Published online January 25, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e5; Funded: Ministry of Health and Welfare

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Abstract PDF: Remote collaborative care is a program that improves medical services by linking local and remote physicians with residents in areas where access to medical facilities is limited, utilizing information and communication technology. As a result, patients can obtain medical advice and counseling at local hospitals without needing to travel to distant facilities. This care model involves communication between doctors, facilitating the accurate transfer of medical information and reducing the risk of misunderstandings. For instance, managing conditions such as blood pressure or blood glucose is more straightforward because a local hospital can assess the patient's status while a remote hospital simultaneously provides high-quality, specialized medical services. With the rise in poorly controlled hypertension or diabetes, the need for remote collaborative care has also increased. This care model enables local hospitals to maintain continuous patient care with the support of remote facilities. This is particularly true following acute cardiovascular treatment, where local hospitals, assisted by remote institutions, can safely offer high-quality services such as rehabilitation and follow-up care. Although remote hospitals have many advantages with the increasing number of patients, many difficulties remain in commercializing unsystematized remote collaborative care. Specifically, low reimbursements for medical services must be addressed, proper equipment is needed, more time and effort must be invested, and the liability issue must also be dealt with. Nevertheless, remote collaborative care using information and communication technology will be necessary in the future. Medical staff need to objectively examine the advantages and disadvantages of remote collaborative care from various perspectives and find ways to revitalize it.

Original Articles

Relationship between serum ferritin levels during iron chelating therapy and diastolic left ventricular function in transfusion-induced iron overload: a 2-year follow-up study in patients with aplastic anemia: Woo-Baek Chung; Cardiovasc Prev Pharmacother. 2023;5(3):81-90. Published online July 26, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e11; Funded: Catholic Research Institute for Intractable Cardiovascular Disease, Catholic University of Korea

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Abstract PDF: Background
The goal of the study was to investigate changes in cardiac function during iron chelating therapy (ICT) in patients with transfusion-induced iron overload.
Methods
We prospectively examined cardiac function in 21 aplastic anemia patients for 2 years by using transthoracic echocardiography before and during ICT.
Results
The serum ferritin level decreased from 4,961.5±2,917.9 µg/L to 2,466.9±2,533.1 µg/L after 2 years (P<0.001). The left ventricular ejection fraction decreased to under the normal limit (55%) in five patients. The serum ferritin level was positively correlated with the E/E’ ratio (r=0.595, P=0.004) and the left atrial (LA) volume (r=0.685, P=0.001) and negatively correlated with the deceleration time (r=–0.586, P=0.005) after 2 years of ICT. The seven responders (serum ferritin level <1,000 µg/L after 2 years of ICT) demonstrated a significantly higher ejection fraction, smaller LA volume and left ventricular end-systolic dimension, and a slower deceleration time than the 14 nonresponders (≥1,000 µg/L).
Conclusions
These results suggest that the response to ICT, which was estimated by the serum ferritin level, can reflect cardiac function during ICT. In nonresponders, cardiac function monitoring during ICT may be helpful for the early detection of cardiac dysfunction.

Correlation between metformin intake and prostate cancer: Raeun Kim, Minsun Song, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2023;5(3):91-97. Published online July 31, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e12; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF: Background
The relationship between metformin intake and prostate cancer incidence remains unclear. Therefore, we examined the correlation between prostate cancer and metformin use.
Methods
The subjects were diabetes patients aged ≥50 years who had been diagnosed with prostate cancer and had undergone surgery at Seoul St. Mary's Hospital. Groups taking metformin (MET(+) group) and not taking metformin (MET(–) group) were divided and compared.
Results
The mean preoperative prostate-specific antigen (PSA) levels in the MET(–) and MET(+) groups were 10.7±11.9 and 8.0±5.6 ng/mL, respectively, with no statistically significant difference between the two groups (P=0.387). The average prostate volume of the MET(–) group was 82.4±98.0 mL, and the average prostate volume of the MET(+) group was 55.4±20.1 mL, but there was no statistically significant difference between the two groups (P=0.226). The mean PSA velocity also did not show a significant difference between the two groups (0.025±0.102 ng/mL vs. 0.005±0.012 ng/mL, P=0.221).
Conclusions
We did not identify a significant positive correlation between metformin and prostate cancer. However, preoperational PSA and PSA velocity tended to be lower in the MET(+) group. A sophisticated prospective study with a large sample size should be planned.

Review Article

Optimal target blood pressure in older patients with hypertension: Kwang-il Kim; Cardiovasc Prev Pharmacother. 2023;5(2):41-48. Published online April 24, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e4; Funded: Korea National Institute of Health

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Abstract PDF: Hypertension is a common condition among older adults, and blood pressure (BP) control is effective for preventing cardiovascular morbidity and mortality even among the oldest-old adults. However, the optimal target BP for older patients with hypertension has been a subject of debate, with previous clinical trials providing conflicting evidence. Determining the optimal target BP for older adults is a complex issue that requires considering comorbidities, frailty, quality of life, and goals of care. As such, BP targets should be individualized based on each patient's unique health status and risk factors, and treatment should be closely monitored to ensure that it is effective and well-tolerated. The benefits and risks of intensive BP control should be carefully weighed in the context of the patient's overall health status and treatment goals. Ultimately, the decision to pursue intensive BP control should be made through shared decision-making between patients and their healthcare providers.

Original Article

Correlation analysis of cancer incidence after pravastatin treatment: Jin Yu, Raeun Kim, Jiwon Shinn, Man Young Park, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2023;5(2):61-68. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e6; Funded: Daiichi Sankyo Korea

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Abstract PDF: Background
Few studies have investigated the cancer-preventive effects of statins, which are known to protect against cardio-cerebrovascular diseases. In this study, we analyzed the degree to which pravastatin, a low-potency statin, could prevent cancer.
Methods
This retrospective cohort study used data from the Korean National Health Insurance Service database. Patients diagnosed with diabetes after the age of 50 years were divided into a pravastatin group and a control group that did not receive any statin prescriptions.
Results
This study included 557 patients in the pravastatin group and 2,221 patients in the control (no statin) group. During the 5-year follow-up, the incidence of cancer was 16.7% (93 of 557 patients) in the pravastatin group and 19.9% (442 of 2,221 patients) in the control group. The incidence of cancer was 22% higher in the control group than in the pravastatin group (hazard ratio, 1.22; 95% confidence interval, 0.97–1.52; P=0.09). Death from various causes occurred at a 45% higher frequency in the control group than in the pravastatin group (hazard ratio, 1.45; 95% confidence interval, 0.99–2.12; P=0.06). However, neither of those relationships reached statistical significance.
Conclusions
Although pravastatin use did not show a significant causal relationship with cancer incidence, fewer cases of cancer occurred in pravastatin users than in controls. However, further large-scale studies are required to confirm these findings.

Review Article

Liraglutide, a glucagon-like peptide-1 analog, in individuals with obesity in clinical practice: Juyoung Shin, Raeun Kim, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2023;5(2):49-53. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e7; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF: Obesity is a disease requiring treatment. The prevalence of obesity is steadily increasing both in Korea and worldwide. Individuals with obesity are at elevated risks of diabetes, cerebrovascular disease, and solid cancer; therefore, obesity is now considered to be a disease requiring treatment, rather than merely a cosmetic problem. Nutrition and exercise are the basic forms of obesity management, but it is not easy to lose weight through only one’s own willpower. Accordingly, policies for establishing a cultural environment that encourages desirable behaviors are proposed through multifaceted efforts involving the media and local organizations. However, the pharmacological and surgical treatments selected as medical interventions should be individualized based on an understanding of each individual’s cause of obesity and characteristics. It is important to understand how to enhance and maintain the effectiveness of treatment not only for the prescribing medical staff, but also for the individual with obesity who is being treated.

Original Article

Modifiable risk factors for coronary artery disease in the Indonesian population: a nested case-control study: Anggoro Budi Hartopo, Maria Patricia Inggriani, Brilliant Winona Jhundy, Jajah Fachiroh, Putri Tiara Rosha, Ratri Kusuma Wardani, Fatwa Sari Tetra Dewi; Cardiovasc Prev Pharmacother. 2023;5(1):24-34. Published online January 31, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e3; Funded: Ministry of Education, Culture, Research, and Technology

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Abstract PDF: Background
There is a lack of data on modifiable coronary artery disease (CAD) risk factors in the Indonesian population, hindering the implementation of assessments and prevention programs in this population. This study investigated modifiable risk factors for CAD among Indonesians by comparing them between CAD-proven patients and healthy subjects from a similar population.
Methods
In this nested, matched case-control study, the cases were patients from a referral hospital in Yogyakarta, Indonesia and the controls were respondents in a population surveillance system in Yogyakarta, Indonesia. The cases were 421 patients who had undergone coronary angiography, showing significant CAD. The sex- and age-matched controls were 842 respondents from the Universitas Gadjah Mada Health and Health and Demographic Surveillance System Sleman who indicated no CAD presence on a questionnaire. The modifiable CAD risk factors compared between cases and controls were diabetes mellitus, hypertension, central obesity, smoking history, physical inactivity, and less fruit and vegetable intake. A multivariate regression model was applied to determine independent modifiable risk factors for CAD, expressed as adjusted odds ratios (AORs).
Results
A multivariate analysis model of 1,263 subjects including all modifiable risk factors indicated that diabetes mellitus (AOR, 3.32; 95% confidence interval [CI], 2.09–5.28), hypertension (AOR, 2.52; 95% CI, 1.76–3.60), former smoking (AOR, 4.18; 95% CI, 2.73–6.39), physical inactivity (AOR, 15.91; 95% CI, 10.13–24.99), and less fruit and vegetable intake (AOR, 5.42; 95% CI, 2.84–10.34) independently and significantly emerged as risk factors for CAD.
Conclusions
Hypertension, diabetes mellitus, former smoking, physical inactivity, and less fruit and vegetable intake were independent and significant modifiable risk factors for CAD in the Indonesian population.

Review Article

The effects and side effects of liraglutide as a treatment for obesity: Jeonghoon Ha, Jin Yu, Joonyub Lee, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2022;4(4):142-148. Published online October 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e18; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF

The incidence of obesity is increasing throughout the world, including Korea. Liraglutide, the main purpose of which is glucose control, has recently gained significant attention due to its additional effect on weight loss. Liraglutide injections have been widely used as an important treatment for obese patients in Korea. In addition to weight loss, liraglutide has various other effects, such as prevention of cardiovascular disease. Despite its excellent effect on weight loss, notable side effects, such as nausea and vomiting, have also been associated with liraglutide. Despite these side effects, liraglutide has not been discontinued due to its beneficial effects on weight loss. Nonetheless, there are reports wherein patients did not experience weight loss upon taking the drug. As such, there is a possibility of liraglutide misuse and abuse. Therefore, physicians need to have a broad understanding of liraglutide and understand the advantages and disadvantages of liraglutide prescription.

Citations

Citations to this article as recorded by

Natural product-based treatment potential for type 2 diabetes mellitus and cardiovascular disease
Dharmsheel Shrivastav, Satyam Kumar Kumbhakar, Shivangi Srivastava, Desh Deepak Singh
World Journal of Diabetes.2024; 15(7): 1603. CrossRef

Original Articles

Development of a predictive model for the side effects of liraglutide: Jiyoung Min, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2022;4(2):87-93. Published online April 27, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e12; Funded: National Research Foundation of Korea, Ministry of Science and ICT

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Abstract PDF Supplementary Material

Background
Liraglutide, a drug used for the management of obesity, has many known side effects. In this study, we developed a predictive model for the occurrence of liraglutide-related side effects using data from electronic medical records (EMRs).
Methods
This study included 237 patients from Seoul St. Mary's Hospital and Eunpyeong St. Mary's Hospital who were prescribed liraglutide. An endocrinologist obtained medical data through an EMR chart review. Model performance was evaluated using the mean of the area under the receiver operating characteristic curve (AUROC) with a 95% confidence interval (CI).
Results
A predictive model was developed for patients who were prescribed liraglutide. However, 37.1% to 75.5% of many variables were missing, and the AUROC of the developed predictive model was 0.630 (95% CI, 0.551–0.708). Patients who had previously taken antiobesity medication had significantly fewer side effects than those without previous antiobesity medication use (20.7% vs. 41.4%, P<0.003). The risk of side effect occurrence was significantly higher in patients with diabetes than in patients without diabetes by 2.389 times (odds ratio, 2.389; 95% CI, 1.115–5.174).
Conclusions
This study did not successfully develop a predictive model for liraglutide-related side effects, primarily due to issues related to missing data. When prescribing antiobesity drugs, detailed records and basic blood tests are expected to be essential. Further large-scale studies on liraglutide-related side effects are needed after obtaining high-quality data.

Citations

Citations to this article as recorded by

The effects and side effects of liraglutide as a treatment for obesity
Jeonghoon Ha, Jin Yu, Joonyub Lee, Hun-Sung Kim
Cardiovascular Prevention and Pharmacotherapy.2022; 4(4): 142. CrossRef

Indirect comparison of nonvitamin K oral anticoagulants and left atrial appendage occlusion: Sung-Hwan Kim, So-Yoon Park, Seung-Sik Hwang; Cardiovasc Prev Pharmacother. 2022;4(1):18-25. Published online January 18, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e1; Funded: Catholic Medical Center Research Foundation

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Abstract PDF Supplementary Material: Background
Anticoagulation is important in atrial fibrillation (AF) patients to reduce the occurrence of thrombotic events. We evaluated the efficacy and safety of percutaneous left atrial appendage occlusion (LAAO) as an alternative to systemic anticoagulation through an indirect comparative analysis.
Methods
An indirect comparative analysis of nonvitamin K oral anticoagulants (NOACs) and LAAO was conducted. Comparisons were made using data from four landmark randomized clinical trials (RE-LY, ROCKET-AF, ARISTOTLE, and PROTECT AF). Using warfarin as the common comparator, an indirect comparison was performed using data from each trial, and the relative risk was calculated between NOACs and LAAO.
Results
NOACs and LAAO showed similar results for the reduction of stroke and systemic embolism, with a non-statistically significant trend favoring NOACs (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.37–1.46 for dabigatran; HR, 0.99; 95% CI, 0.50–1.92 for rivaroxaban; HR, 0.89; 95% CI, 0.45–1.74 for apixaban). Significantly fewer major bleeding and procedure-related complications were found in patients treated with apixaban compared with LAAO (HR, 0.45; 95% CI, 0.26–0.75). Cardiovascular death occurred more frequently in patients administered NOACs than in patients with LAAO (HR, 2.28; 95% CI, 1.03–5.10 for dabigatran; HR, 2.41; 95% CI, 1.09–5.42 for rivaroxaban; HR, 2.40; 95% CI, 1.10–5.36 for apixaban).
Conclusions
The rate of all-cause death was similar between NOACs and LAAO. Compared with LAAO, NOACs led to a nonsignificant numerical decrease in stroke and embolism in AF patients. Significantly fewer safety events occurred in patients treated with apixaban. LAAO significantly reduced cardiovascular death.

Review Article

Anti-inflammatory effects of colchicine on coronary artery disease: Hun-Jun Park; Cardiovasc Prev Pharmacother. 2022;4(1):7-12. Published online January 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e5; Funded: National Research Foundation of Korea

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Abstract PDF: Inflammation plays a crucial role in the pathophysiology of coronary artery disease (CAD). Several types of sterile inflammation are mediated through the nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 (NLRP3) inflammasome. Colchicine has recently been shown to effectively block NLRP3 inflammasome assembly in addition to several other actions on inflammatory cells. Recent evidence also points to favorable effects of colchicine in patients with CAD, including lower levels of inflammatory markers, coronary plaque stabilization, and more favorable cardiac recovery after injury. This review focuses on the role of colchicine in the process of atherosclerosis and discusses its potential as a therapeutic option for the prevention and treatment of CAD.

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