Transcription
You see this tiny pill? A lot of people are saying this is the best new way to help heal your arteries. It's not aspirin, and it's certainly not a statin. And in fact, it doesn't even remove clots or reduce cholesterol. So, why is it making headlines? Why are so many people talking about that?
In this video, I'll break down the new research that explains how that pill, this one right here, might not just heal, but even reverse the plaque in your arteries. Who should consider taking it, and the important side effects you need to know about before you ever consider taking it. So, let's get started.
Now, let me tell you what the pill is. It's colchicine. Before we get geeky, let me give you an example of how colchicine can be used. And be aware, we're talking about low-dose colchicine. Yep, the stuff that used to be used for gout and some other arthritis problems.
A few months ago, I had a patient. We'll call him Ray. Ray came to me stuck. His doctor had put him on a statin years earlier. The standard move for a man with his cholesterol, but every time he took it, his legs ached so badly he could barely finish his morning walk. He tried three different statins, and it was the same result every time. So, eventually, he just gave up on them. He quit his statins, and that left him scared because he knew his arteries were still a problem, and now he felt like he had nothing protecting him.
When we tested him, his cholesterol turned out to be really a small part of the story. Very small part. What really stood out was his inflammation. Vascular inflammation. It's markers in his blood that were running high and telling us there was an active process damaging his arteries from the inside.
But here's something that most people ignore. Plaque isn't grease collecting in a pipe. It's an inflammatory process. It means your own immune system is reacting inside the wall of the artery, building up deposits and keeping them irritated and unstable. A statin can help reduce both cholesterol and inflammation, but the problem is most doctors prescribe it at very high doses and just for cholesterol. They never even look at inflammation. You don't need high doses for inflammation.
So, you can end up in one of two hard spots. Either you can't tolerate the statin in the first place, like Ray, or you take it, your cholesterol looks great, and you end up thinking a statin is all you needed to fix your health. Meanwhile, the damage is continuing underneath. Doctors have a name for that leftover danger. They call it residual inflammatory risk. They often don't know what to do of for it. That's They usually don't, and that's a big, big problem. And it adds up to a lot of risk in a lot of people because even on good treatment, somewhere around four out of 10 people still go on to have heart attacks and strokes.
Now, that was Ray's real problem. Not the cholesterol number on his chart, but the fire underneath. It was not being managed. It was not being taken care of. They didn't even know it was going on.
Now, the key question is, how does colchicine help with this? The answer is more interesting than anyone expected. The first thing colchicine does is quiet a specific inflammatory alarm inside the plaque. Picture that alarm as the signal your immune system uses to call in reinforcements, more inflammation, more damage. And colchicine turns that volume down. The second thing that colchicine does is it calms the immune cells that crawl into the plaque and chew at that plaque from the inside, the ones that leave that plaque fragile. And the third effect is the one that's really gotten researchers the most excited.
And to understand why, you need one fact about plaque. There are two kinds of it. Two kinds of plaque. The hard calcified kind is actually fairly stable, and it doesn't give you a whole lot of extra risk. It's been there long enough to harden. It tends to stay put. The soft kind is the dangerous one. It's a thin cap stretched over a greasy, inflamed core. And when that cap tears, your body throws a clot to seal the tear. And that clot is what blocks the artery and causes the heart attack. Unless, of course, it goes to the brain, and then it causes a stroke.
So, here's what sets colchicine apart. The newest research suggests that it changes the cells inside the plaque. They lay down a thicker, tougher cap now over that dangerous core. It's not emptying the artery out. It's reinforcing the roof over the most unstable part of it. And this, by the way, is something that can be going on. You can be showering your body with microscopic clots and never even know it. What do you think causes the uh some of the damage that results in dementia? You look microscopically at the brain, and it can look like microscopic versions of Swiss cheese. Same thing for the heart. These are causes of heart failure and dementia.
So, you need to know if this is going on. And this is why I keep coming back to this for the men that I treat. The heart attack I worry about isn't the obvious one with the chest pain and the warning signs, and you get to avoid death associated with that because you go to the hospital. it's the quiet one that drops the man on his morning walk in arteries that looked perfectly fine on every standard test he ever took. The man who still has a wife next to him on the couch, grandkids who expect him at their games, a community that counts on him, a job, a company that needs him, a church that needs him. So, what soft plaque really threatens isn't only your life, it's your ability to keep showing up for the people who are counting on you.
But, there's a big difference between building a stronger cap and actually shrinking the plaque. So, which one can the science really back up for colchicine? The results on heart attacks and strokes are strong, and they come from large, serious trials, not small studies that you can just wave away and say maybe a statistical variance. In one big trial of people who'd already had a heart attack, adding colchicine cut their risk of another major event by about 23%. In another, in people with stable heart disease, the drop was even larger, around medications, it's nowhere near as good as a 10 or 20-lb weight loss and lifestyle changes, but still very significant for a medication. And when researchers pulled more than 20,000 patients together to get the clearest possible picture, the benefits settled at roughly a 25% reduction in events, very, very significant. So, this is important medication. That's why you hear so many people talking about it.
Now, on the question of fewer heart attacks and strokes, the evidence is solid. But, the harder question is the one in the headlines. Some of them are saying it clears the plaque out. Now, to answer that, researchers did something more demanding. In a trial called Ekstrom, e k s t r o m, they scanned people's arteries in detail, put them on colchicine for a year, and then scanned them again to measure the plaque directly. The measure they cared about most was that dangerous soft plaque, the kind we just talked about. Now, on that specific measure, the results didn't quite clear the bar. They couldn't say with confidence that this soft plaque shrank. What did improve was the total amount of plaque, which came down by a modest but real amount.
So, let me give you a fair size my perspective on it. Colchicine clearly lowers your risk of a heart attack or stroke. It slows the disease down and it modestly reduces the overall plaque that you're carrying. What it hasn't proven it can do is scrub an artery clean the way many people are saying. I just don't believe that. Now, stabilize and slow with a real shot at some shrinkage, that's the true size of the claim and it's a claim clearly worth paying attention to.
So, now you're probably asking yourself that question, is this pill right for me? And how much should I take if it is? The way you answer that is by looking at your inflammation. The good news is we can actually measure that. Most people have only ever had their cholesterol checked, but there's a whole panel of blood markers that show whether your arteries are inflamed. We've done a lot of videos on them. I'm going to talk a little bit about it right now. We do this in our clinic and we do it with our heart reveal panel. The only one you may have heard of out of the inflammation panel that we use is C-reactive protein, high-sensitivity CRP. It's a protein in your body. It's made by the liver and it shows whenever there's inflammation anywhere inside of you, even a cut or a bruise sometimes or a sore throat. The time that I had an elevated CRP was right after a sore throat. It was over 10. It was very, very high. But, that's not very specific for vascular inflammation. So, we look at other vascular inflammation markers, as well. Things like MPO, myeloperoxidase, which points actively to unstable plaque. And LP-PLA2, it's a marker tied specifically to inflammation in the artery wall. Then, there's things like the microalbumin to creatinine ratio. It's an early sign of damage to the blood vessels themselves. So, these are all really looking at the vascular inflammation itself, rather than just general inflammation, which you get with a CRP. And again, there are very few docs that look for inflammation in heart attack and stroke risk, vascular risk. Of those that do, almost all just use CRP. You need to add a few of the others, at least one or two. Speaking of the others, there's also fibrinogen and others, again, like this. You don't need to memorize the alphabet soup here. There's over a dozen, couple of dozen. Here's what matters. When one of these is running high, you need to look and see, is there a general picture of having a fire in your arteries? We've been talking about that fire. Is it still burning? Even though your cholesterol looks perfect, because that's what's happening over and over in medicine today. You go to the doc, the doc looks for a high cholesterol, writes you a script, and never even looks for inflammation. This is exactly the situation that colchicine was built for.
So, if any of those inflammatory markers are elevated, despite good treatment, you're carrying the kind of risk this drug goes after. That points to a specific group of people. Now, the strongest case is someone in the first few days after heart attack. And the timing really matters for those people. The earlier it started inside that window post heart attack, the more it helps. Then there are people with stable heart disease whose inflammation just won't come down. We see that a lot. People who've had a stent placed, people already carrying a lot of plaque in their scans. And there are people like Ray who just can't tolerate a statin. Or trying to take a statin, can't tolerate it, needs some help in terms of inflammation. If you see yourself anywhere in any of these categories, it's a real conversation to have with your doctor. And if your doctor doesn't know anything about this, you need to find a new doctor.
As for how much to take, what is the dosage when we're talking about low dose colchicine? There's a little bit of complication there, but usually you can get through it pretty simply. The Colcot trials and the Lodoca trials, they used half a milligram. This is 0.6 milligrams. And don't worry about the difference on that. Either one works well. Now, you can get into some debate on that and I will be happy to debate anybody that wants to debate it. The 0.6 is the one that's most commonly available, even though the 0.5 was the one that was researched. Anyhow, the dose is really the easy part. The hard part is everything that has to happen before that first pill, measuring those inflammatory markers, checking how well your kidneys are working, getting through every other medication you take to make sure there's not any significant interactions. None of that's something you really sort out from looking at a video or a supplement advertisement or shelf. Colchicine is a prescription. And it does belong in the hands of a doctor who measures your risk instead of just guessing at it. And it sits on top of the foundation, the lifestyle, the food, the movement, the diet, the sleep. It never replaces that. It's way down the list. Lifestyle is at the top, but except for one other thing. There's one thing that might be more important than lifestyle, and that is knowing what the heck's going on. Test, don't guess. Then that can tell you what to do with your lifestyle. So to go back down all the way to the end, the pill, and sometimes this pill is indicated for a lot of people that aren't taking it. The pill supports the work. It doesn't do the work for you. >> [snorts] >> But before you get too excited about it, there's a flip side that you have to hear, and that's why it's a prescription medication. Some people should only take it during certain times. Here's what makes colchicine different from a vitamin you grab off the shelf, something that doesn't have significant risk. The gap between a dose that helps you and a dose that poisons you is narrow. This means a few specific situations turn it from helpful into dangerous, and getting this wrong can land you in real trouble.
Sometimes the trouble is something that keeps you close to the bathroom all day. The biggest issue is other medications. There are common drugs that block the way your body clears colchicine. So it quietly builds up to toxic levels without you ever even knowing it. You don't realize it, but you're toxic with colchicine. A used antibiotic, for example, called clarithromycin is the classic example. Certain statins can do it, too, along with a couple of common heart rhythm drugs like verapamil and diltiazem. These last groups, especially the statins, are so common, you really need to be careful thinking through what else you're taking if you decide to take colchicine. Your body clears colchicine through your kidneys and your liver. So, if either of those is failing, the drug stacks up where it shouldn't. And there's one more thing I'm not going to gloss over because you deserve the whole picture. In the trial data, there was a small signal of more deaths from causes unrelated to the heart. Now, researchers are still sorting that out. Is it real or it was it a fluke of just what happened in that study? I suspect, personally, it was a fluke, but again, that's a suspicion. That's not got a lot of evidence behind it.
So, anyway, this is not a drug you experiment with on your own. That's the whole reason it runs through a physician who can see your entire medication list and your lab work. And knows whether or not you've got some of the risk factors like kidney or liver disease. The right person, inflammation still up, kidneys healthy, no drug conflicts, stands to get a real benefit. The wrong person stands to get hurt. The only thing standing between those two outcomes is measurement. Someone checking instead of hoping that it'll be fine.
But there's also one last piece, and that's the one most people watching this are going to walk right past because the thing that decides whether colchicine is ever worth it for you is the same thing a normal stress test and a standard cholesterol were never built to find. And the only way to know whether you have that fire in your arteries is to measure it. That's exactly what we do at my clinic. We find what's actually driving risk for the our patient and then we build the plan around it. It starts with a short no pressure call to see if you're a fit if you want to go there. Um and just go to prevmedcare.com, fill out your information uh book your call right there on the calendar and the link is in the description. And if you're not ready before that, don't worry about that. You're getting a lot of great information. You now know what to take to your doctor. And our folks that become patients tell us they do that all the time. They watch our videos, they go to their doctor and they get in a totally different conversation than they were before. If you want to just get a free guide on the tests and the markers that matter for this you can go to a link as well.
Now, if this helped you see your arteries a little more clearly, consider subscribing. It really helps the algorithm to know that this is important information. It's how these videos find the next person who needs them. Growing old's not for sissies but it is a lot better with healthy arteries. Thanks for watching.