It’s a finding that sounds almost too good to be true: Brigham and Women’s Hospital (BWH) research suggests that a single drug could cut a patient’s risk of heart attack, stroke, and lung cancer, all by lowering levels of inflammation in the body.
The apparent wonder drug is canakinumab, a Novartis-developed pharmaceutical that targets inflammation. And if BWH’s studies are any indication, this won’t be the last you hear of it.
The results are the culmination of 25 years of research led by Paul Ridker, the director of the Center for Cardiovascular Disease Prevention at BWH. Working off the observation that half of heart attack patients do not have high cholesterol—even though cholesterol is the focus of most heart attack interventions—Ridker launched the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS). The trial, which was sponsored by Novartis, sought to determine whether reducing inflammation, rather than targeting cholesterol, could ward off future heart problems in patients who had already suffered a heart attack.
The hypothesis was a revolutionary one, as anti-inflammatories have never been used in this way. It also appears to have been a correct one, according to a study published Sunday in the New England Journal of Medicine. In it, Ridker reports that lowering levels of inflammation may reduce a patient’s risk of recurrent cardiac events by an average 15 percent, and as much as 30 percent. The drug also significantly lessened the need for procedures such as bypass surgery and angioplasty, though it did increase the risk of fatal infections in roughly one out of 1,000 patients.
Researchers gave 10,000 heart attack patients with high levels of inflammatory markers either 50-, 150-, or 300-milligram doses of canakinumab every three months, in addition to a standard course of cholesterol-lowering statins. (A control group got a placebo instead of the anti-inflammatory.) After four years of follow-up, researchers noticed marked improvements, above and beyond those attributable to statins, in the 150- and 300-milligram populations. Though it’s early days, this suggests that inflammation-based treatments may be more successful than statins for certain patients.
“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,” Ridker says in a statement.
That, alone, would have been an exciting finding. But Ridker also found a happy side effect of canakinumab.
In a separate study published in the Lancet, Ridker writes that CANTOS patients taking canakinumab saw a marked reduction in lung cancer mortality as well as cardiovascular disease. What’s more, none of the 10,000 CANTOS patients had cancer at study outset, meaning the drug actually appears to slow the progression and invasiveness of cancer in a notoriously high-risk population.
“My primary interest is in heart disease, but my colleagues and I were aware of experimental research indicating a connection between cancer and inflammation, and we recognized that our cardiovascular clinical trial could be the perfect place to explore this link,” Ridker says in a statement. “The data are exciting because they point to the possibility of slowing the progression of certain cancers.”
While Ridker cautions that the study was exploratory and must be replicated by further research, the results are staggering. Compared to those on the placebo, patients on the highest dose of canakinumab saw total cancer deaths cut in half, and lung cancer deaths cut by a quarter.
Ridker still has quite a bit of work ahead of him. He’ll continue studying inflammation and cardiovascular disease, looking at other potential drugs and treatments—a must, since it’s unclear whether canakinumab could ever be an affordable option for patients. Laurie Glimcher, president and CEO of Dana-Farber Cancer Institute, also says in a statement that her researchers will partner with Ridker and his team to continue evaluating anti-inflammatory treatments for lung cancer.
“In my lifetime, I’ve gotten to see three broad eras of preventative cardiology,” Ridker says in the statement. “In the first, we recognized the importance of diet, exercise and smoking cessation. In the second, we saw the tremendous value of lipid-lowering drugs such as statins. Now, we’re cracking the door open on the third era. This is very exciting.”
Source URL: https://www.bostonmagazine.com/health/2017/08/29/inflammation-heart-attack/
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