Timing the Taming of Vascular Inflammation

This editorial examines vascular inflammation in atherothrombosis and assesses whether early anti-inflammatory intervention can improve outcomes in patients with acute myocardial infarction.

The article reflects on two trials:

- Colchicine in Acute Myocardial Infarction (CLEAR), which explored whether early colchicine therapy (within 28.4 hours of symptom onset) could improve outcomes. Despite prior success in the COLCOT trial, CLEAR found no significant reduction in cardiovascular events, likely due to adverse effects on endothelial function, impaired fibrinolysis, and enhanced leukocyte accumulation at angioplasty sites.

- Routine Spironolactone in Acute Myocardial Infarction, which tested mineralocorticoid receptor antagonism post-MI, but failed to demonstrate benefit, likely because its anti-inflammatory actions were countered by adverse vascular effects.

This editorial examines vascular inflammation in atherothrombosis and assesses whether early anti-inflammatory intervention can improve outcomes in patients with acute myocardial infarction.

The article reflects on two trials:

- Colchicine in Acute Myocardial Infarction (CLEAR), which explored whether early colchicine therapy (within 28.4 hours of symptom onset) could improve outcomes. Despite prior success in the COLCOT trial, CLEAR found no significant reduction in cardiovascular events, likely due to adverse effects on endothelial function, impaired fibrinolysis, and enhanced leukocyte accumulation at angioplasty sites.

- Routine Spironolactone in Acute Myocardial Infarction, which tested mineralocorticoid receptor antagonism post-MI, but failed to demonstrate benefit, likely because its anti-inflammatory actions were countered by adverse vascular effects.