Aernoud T L Fiolet1,2, Tjerk S J Opstal3,4, Arend Mosterd2,5,6, John W Eikelboom7, Sanjit S Jolly8, Anthony C Keech9, Peter Kelly10, David C Tong11,12, Jaimie Layland11,12,13, Stefan M Nidorf14,15, Peter L Thompson14,16,17, Charley Budgeon17, Jan G P Tijssen18,19, Jan H Cornel2,3,4. 1. Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands. 2. Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands. 3. Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands. 4. Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands. 5. Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands. 6. Julius Centre for Health Sciences and Primary Care, Utrecht University Medical Centre, Utrecht, The Netherlands. 7. Department of Medicine, McMaster University, Hamilton, ON, Canada. 8. Division of Cardiology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada. 9. Sydney Medical School, National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia. 10. Mater University and Health Research Board (HRB) Stroke Clinical Trials Network Ireland, University College Dublin, Ireland. 11. Department of Medicine, St. Vincent's Hospital Melbourne, VIC, Australia. 12. Department of Cardiology, St. Vincent's Hospital Melbourne, VIC, Australia. 13. Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia. 14. Heart and Vascular Research Institute of Western Australia, Perth, Australia. 15. GenesisCare Western Australia, Perth, Australia. 16. Sir Charles Gairdner Hospital, Perth, Australia. 17. School of Population and Global Health, University of Western Australia, Perth, Australia. 18. Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands. 19. Cardialysis BV, Rotterdam, The Netherlands.
Abstract
AIMS: Recent randomized trials demonstrated a benefit of low-dose colchicine added to guideline-based treatment in patients with recent myocardial infarction or chronic coronary disease. We performed a systematic review and meta-analysis to obtain best estimates of the effects of colchicine on major adverse cardiovascular events (MACE). METHODS AND RESULTS: We searched the literature for randomized clinical trials of long-term colchicine in patients with atherosclerosis published up to 1 September 2020. The primary efficacy endpoint was MACE, the composite of myocardial infarction, stroke, or cardiovascular death. We combined the results of five trials that included 11 816 patients. 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], myocardial infarction 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). We observed no difference in all-cause death (RR 1.08, 95% CI 0.71-1.62; P = 0.73), with a lower incidence of cardiovascular death (RR 0.82, 95% CI 0.55-1.23; P = 0.34) counterbalanced by a higher incidence of non-cardiovascular death (RR 1.38, 95% CI 0.99-1.92; P = 0.060). CONCLUSION: Our meta-analysis indicates that low-dose colchicine reduced the risk of MACE as well as that of myocardial infarction, 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 cardiovascular deaths were counterbalanced by more non-cardiovascular deaths. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Recent randomized trials demonstrated a benefit of low-dose colchicine added to guideline-based treatment in patients with recent myocardial infarction or chronic coronary disease. We performed a systematic review and meta-analysis to obtain best estimates of the effects of colchicine on major adverse cardiovascular events (MACE). METHODS AND RESULTS: We searched the literature for randomized clinical trials of long-term colchicine in patients with atherosclerosis published up to 1 September 2020. The primary efficacy endpoint was MACE, the composite of myocardial infarction, stroke, or cardiovascular death. We combined the results of five trials that included 11 816 patients. 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], myocardial infarction 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). We observed no difference in all-cause death (RR 1.08, 95% CI 0.71-1.62; P = 0.73), with a lower incidence of cardiovascular death (RR 0.82, 95% CI 0.55-1.23; P = 0.34) counterbalanced by a higher incidence of non-cardiovascular death (RR 1.38, 95% CI 0.99-1.92; P = 0.060). CONCLUSION: Our meta-analysis indicates that low-dose colchicine reduced the risk of MACE as well as that of myocardial infarction, 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 cardiovascular deaths were counterbalanced by more non-cardiovascular deaths. Published on behalf of the European Society of Cardiology. All rights reserved.
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