Colchicine, SIHD, and Secondary Prevention
A 66-year-old man with a history of hypertension and coronary artery disease presents for an annual follow-up appointment. Two years ago, he underwent revascularization of his left circumflex artery with a drug-eluting stent in the setting of an ST-segment elevation myocardial infarction. He has had normal left ventricular function since then. He works as an accountant. He can climb 2 flights of stairs without symptoms, and every other weekend he swims 2 miles without any limitations. He is concerned about his risk of future cardiovascular events, particularly the risk of having another myocardial infarction. He is 5 feet 2 inches tall and weighs 160 pounds. His blood pressure is 118/78 mmHg, and his heart rate is 74 bpm. His medications include aspirin 81 mg daily, metoprolol succinate 50 mg daily, losartan 50 mg daily, and atorvastatin 80 mg daily. His laboratory values are significant for hemoglobin A1c of 5.4, creatinine of 2.2 mg/dl (estimated glomerular filtration rate of 28 mL/min), C-reactive protein level of 1.7 mg/dl, and a normal complete blood count. His last low-density lipoprotein cholesterol level was 98 mg/dl.
Based on the LoDoCo2 (Low Dose Colchicine for Secondary Prevention of Cardiovascular Disease 2) trial, should low-dose daily colchicine therapy be prescribed to decrease the risk of an acute cardiovascular event?