Treating inflammation reduces stroke risk

Treating inflammation in patients can have a significant impact on their stroke risk, one of Ireland’s leading stroke experts told the INA 2022 Annual Meeting. 

Prof Peter Kelly, Clinical Professor of Neurology at University College Dublin (UCD) and Co-Director of the stroke service at the Mater Misericordiae University Hospital, Dublin, gave a talk entitled ‘Inf lammation – the new risk factor and treatment target for stroke prevention’. 

Prof Kelly spoke about the importance of both primary and secondary prevention of individual patient stroke risk factors, noting that the residual risk after ischaemic stroke/TIA is substantial. 

He used a case study to demonstrate that plaque inf lammation is common in clinical practice and carotid plaque 18F-FDG PET predicts early recurrent stroke; therefore, anti-inflammatory intervention should be a key strategy. 

Prof Kelly discussed the role of colchicine therapy in reducing the risk of stroke and cardiovascular events. Colchicine is safe, cheap, and widely available, and could have a major role in reducing the amount of stroke and resulting deaths and disability worldwide. 

He quoted a meta-analysis examining the efficacy and safety of low-dose colchicine in five randomised controlled trials (RCTs) of 11,816 patients with coronary disease. This found that colchicine was associated with an approximate 25 per cent relative risk reduction of major recurrent cardiovascular events and was safe in these patients. Although mortality rates were not significantly different, rates of myocardial infarction, stroke, and need for repeat coronary revascularisation were lower among patients treated with colchicine. 

Now there is a major ongoing trial, which Prof Kelly is Chief Investigator of, looking at the role of colchicine in secondary stroke prevention: CONVINCE (COlchicine for preventioN of Vascular Inf lammation in Non-CardioEmbolic stroke) is a multi-centre international, randomised open-label, blinded-endpoint assessment (PROBE) controlled phase 3 clinical trial. The intervention is colchicine 0.5mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Recruitment, which is currently at nearly 3,000 patients and close to target, is due to be complete by late August. Well over 400 Irish patients have been recruited to date. 

Speaking to the Medical Independent, Prof Kelly called for more high-quality research into stroke prevention and treatment and more support for patients when they leave hospital. He stressed the need for clinicians to “intensively” treat their patients’ modifiable stroke risk factors, “to get them within target or well below target.” 

“There is a lot that can be done,” Prof Kelly said. 

“I think in general there is good awareness [of the relevant risk factors], but we really need to translate that into effective implementation for individual patients and that has benefits for all society.”