Colchicine for Secondary Cardiovascular Prevention in Coronary Disease
François Roubille, Jean‐Claude Tardif
Abstract
large body of evidence has demonstrated the important role of inflammation in atherosclerosis. In addition, methotrexate, another agent with anti-inflammatory properties, failed to provide beneficial effects on cardiovascular outcomes or biomarkers of inflammation in a large randomized trial. ] The median duration of follow-up was 22.6 months. Low-dose colchicine reduced the risk of the primary end point of time to first cardiovascular event, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization by 23% compared to placebo. The risk of the total burden of these primary ischemic cardiovascular events (both first and recurrent) was also reduced by 34% with colchicine in COLCOT. The benefit was due to effects on all components of the primary end point, with hazard ratios of 0.26 (95% confidence interval [CI], 0.10-0.70) for stroke; 0.50 (95% CI, 0.31-0.81) for urgent hospitalization for angina requiring coronary revascularization (the main weight); 0.84 (95% CI, 0.46-1.52) for cardiovascular death; and 0.91 (95% CI, 0.68-1.21) for MI. Colchicine was also shown to have a more marked effect on MI when initiated within the first 3 days after the acute coronary syndrome. he results of the LoDoCo2 trial (Low-Dose Colchicine-2) complemented those of COLCOT. LoDoCo2 included 5522 patients with chronic coronary disease who were randomized to receive low-dose colchicine or placebo. Patients were followed for a median duration of 28.6 months. The risk of the primary end point of cardiovascular death, MI, ischemic stroke, or ischemia-driven coronary revascularization was reduced by 31% by colchicine. As compared with placebo, colchicine reduced the risk of cardiovascular death, MI and stroke by 28% and that of MI by 30%.