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Colchicine for Secondary Prevention of Cardiovascular Events
Quick Takes
- A meta-analysis of five recent trials suggests that low-dose colchicine (0.5 mg once daily) was associated with a 25% relative risk reduction of major recurrent CV events.
- Although mortality rates were not significantly different, rates of MI, stroke, and need for repeat coronary revascularization were lower among patients treated with colchicine.
- Colchicine use was not associated with major safety events, although diarrhea was more common. Continued follow-up is still needed to ensure long-term safety.
Study Questions:
Is there clinical benefit of low-dose colchicine when added to guideline-based treatment in patients with recent myocardial infarction (MI) or chronic coronary disease?
Methods:
Randomized clinical trials of long-term colchicine in patients with atherosclerosis published up to September 1, 2020 were analyzed. The primary efficacy endpoint was major adverse cardiac events (MACE), the composite of MI, stroke, or cardiovascular (CV) death.
Results:
Five trials that included 11,816 patients were included. The primary endpoint occurred in 578 patients. Colchicine reduced the risk for the primary endpoint by 25% (relative risk [RR], 0.75; 95% confidence interval [CI], 0.61–0.92; p = 0.005), MI by 22% (RR, 0.78; 95% CI, 0.64–0.94; p = 0.010), stroke by 46% (RR, 0.54; 95% CI, 0.34–0.86; p = 0.009), and coronary revascularization by 23% (RR, 0.77; 95% CI, 0.66–0.90; p < 0.001). They observed no difference in all-cause death (RR, 1.08, 95% CI, 0.71–1.62; p = 0.73), with a lower incidence of CV death (RR, 0.82; 95% CI, 0.55–1.23; p = 0.34) counterbalanced by a higher incidence of non-CV death (RR, 1.38; 95% CI, 0.99–1.92; p = 0.060).
Conclusions:
Results from this meta-analysis indicate that low-dose colchicine reduced the risk of MACE as well as that of MI, stroke, and the need for coronary revascularization in a broad spectrum of patients with coronary disease. There was no difference in all-cause mortality and fewer CV deaths were counterbalanced by more non-CV deaths.
Perspective:
This well-conducted meta-analysis of predominantly older, male patients evaluated whether low-dose colchicine (0.5 mg once daily) and its anti-inflammatory properties lowers the risk of recurrent CV events among a broad spectrum of patients with coronary artery disease. Five recent trials were included in the meta-analysis and findings suggest that low-dose colchicine was associated with a 25% relative reduction in risk of recurrent MI, stroke, or death. Although mortality rates were not significantly different, rates of MI, stroke, and need for repeat coronary revascularization were lower among patients treated with colchicine. Most impressive findings from these results is that the 25% relative reduction was seen when colchicine was added to existing guideline-directed therapy for secondary prevention of atherosclerotic CV disease. Although there was no signal for major safety concerns, longer-term follow-up will be needed.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease
Keywords: Anti-Inflammatory Agents, Atherosclerosis, Colchicine, Coronary Artery Disease, Myocardial Infarction, Myocardial Revascularization, Risk, Secondary Prevention, Stroke, Vascular Diseases
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