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Reduced risk of relapse after a heart attack


Fighting a chronic inflammation of the vascular walls is an effective way of preventing relapse after a heart attack. These are the findings of a study of more than 10,000 patients, published in the New England Journal of Medicine (NEJM).

“This study establishes that the inflammation is the most important when it comes to arteriosclerosis,” says Mikael Dellborg, Professor at the Institute of Medicine at Sahlgrenska Academy, Senior Physician and scientifically responsible for the Swedish part of the study.

Patients who have had a heart attack receive a number of different treatments to reduce the risk of relapse. Blood vessels are dilated, blood thinners are given and the patients are encouraged to stop smoking and change their lifestyle to keep cholesterol and blood sugar levels in check.

In spite of this, some diseases and a distinctive factor for these patients is that they have a remaining and chronic inflammation, measurable with blood tests, where the bodily substance interleukin 1-beta plays a key role.

Reduced risks

In the current so-called Cantos study, all participants had a past heart attack and signs of a remaining chronic inflammation. They were allocated to treatment with either the antibody canakinumab, or a placebo, which was administered by injection every three months.

Canakinumab blocks interleukin 1-beta and has been developed to counteract certain uncommon and congenital diseases with a chronically elevated inflammation. Theoretically, it should accordingly also function to remove the remaining inflammation in patients with a past heart attack.

After three and a half years of treatment, the researchers were able to confirm that the chronic inflammation can be counteracted, and that it provides results in the form of up to a 15 percent lower risk of being struck by a new heart attack, a stroke or death. Specifically for heart attack, the risk is reduced by 24 percent.

New treatment thinking

“Now, we can see that this holds the whole way, also for humans, and it will influence our thinking and way of treating patients with a past heart attack,” says Mikael Dellborg.

“Even if we lower the cholesterol levels in slightly different ways, administer different kinds of medicine to lower blood sugar, offer antidotal smoking treatment and adjust everything really well, there are many people with a remaining chronic inflammation that stays and smolders. Now, we have actually shown that it is this inflammation that is the uniting factor, and if it’s addressed, the risk of relapse decreases,” he continues.

Mikael Dellborg is the main Swedish researcher and scientifically responsible for the Swedish part of the study, with more than 200 participants. In total, more than 40 countries are participating in the study being led by researchers at Brigham and Women’s Hospital and Harvard Medical School, Boston, with Novartis as the sponsor and manufacturer of canakinumab.

Read the article in NEJM.

Send an eamil to Mikael Dellborg.