The scientific community has suspected the virtues of anti-inflammatory drugs in preventing heart attacks for years, but a comprehensive study of 10,000 patients seems to provide the definitive proof. Its results have just been announced at a congress of the European Society of Cardiology held in Barcelona.
Called the Canakinumab Anti-inflamatory Thrombosis Outcomes Study (CANTOS) and sponsored by the pharmaceutical company Novartis, this work was conceived as an attempt to shed light on the dark role of inflammations – the immune system’s reaction to injuries, infections and other threats to our health – in vascular accidents.
Plaque build-up
The first scientific voice to alert to the connection was the American cardiologist Peter Libby, from Brigham and Women’s Hospital in Boston. In the 1980s, Libby suggested that during these defensive processes, certain molecules concentrate macrophages and other immune cells in the blood vessels, which can lead to the creation of plaques in the arteries . That is, to atherosclerosis. In its time it seemed like an outlandish idea, but today no one in the medical community doubts its finding.
What was not known for sure is whether the inflammation is simply limited to promoting atherosclerosis or whether it can also trigger the heart attack itself , which often occurs when plaque tears and clogs an artery. A colleague of Libby, Paul Ridker, investigated this way and concluded that indeed the increase in immune cells predicted the risk of suffering a heart attack . However, statistical studies carried out with anti-inflammatory drugs available on the market – mainly those classified as steroidal and non-steroidal – did not produce the expected results. In fact, one of them, called Vioxx, even doubled the chances of having a heart attack. It was withdrawn from the market in 2004.
Target change
Perhaps it was necessary to refine with the therapeutic substance, change the anti-inflammatory. Libby and Ridker focused on a drug prescribed for sudden juvenile idiopathic arthritis, familial Mediterranean fever, and other illnesses: the monoclonal antibody canakinumab , which blocks the activity of the interleukin 1 beta (IL-1β) molecule, a protein related to both inflammation as with atherosclerosis. The pair of researchers convinced the Novartis company to launch the CANTOS study.
Libby and Ridker were able to bring together 10,000 people affected by a heart attack to see how canakinumab administration affected the chances of having a second heart attack one year after the first. Well, there was a significant effect: according to the follow-up they did, the risk of having that second attack or dying as a result of it decreased by 15% among those who took the drug. In addition, this group needed 30% fewer heart surgeries than volunteers taking placebo, indicating that their arteries remained healthier.
But there are several problems with canakinumab. First, that it is very expensive : it costs about $ 16,000 per dose, which is administered by intravenous infusion. And furthermore, there is a 1% chance that this anti-inflammatory drug will cause a fatal infection, especially among elderly patients with diabetes. Therefore, it is a treatment only recommended for people who have already suffered a heart attack , that is, at high risk of suffering another. In any case, the CANTOS study opens the door to research with other anti-inflammatory drugs and therapeutic strategies to prevent vascular accidents.
