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Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease

Burger, Pascal M; Dorresteijn, Jannick AN; Fiolet, Aernoud TL; Koudstaal, Stefan; Eikelboom, John W; Nidorf, Stefan M; Thompson, Peter L; ... and REACH Registry, Investigators; + view all (2023) Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease. European Journal of Preventive Cardiology zwad221. 10.1093/eurjpc/zwad221. (In press).

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Abstract

BACKGROUND AND AIMS: Low-dose colchicine reduces cardiovascular risk in patients with coronary artery disease (CAD), but absolute benefits may vary between individuals. This study aimed to assess the range of absolute benefit from low-dose colchicine according to individual patient risk profile. METHODS: The ESC guideline-recommended SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to CAD patients from the LoDoCo2 trial and UCC-SMART cohort (n = 10,830). Individual treatment benefit was expressed as 10-year absolute risk reductions (ARRs) for myocardial infarction, stroke, or cardiovascular death (MACE), and MACE-free life-years gained. Predictions were also performed for MACE plus coronary revascularization (MACE+), using a new lifetime model derived in the REACH registry. Colchicine was compared to other ESC guideline-recommended intensified (step 2) prevention strategies, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to 1.4 mmol/L, and systolic blood pressure (SBP) reduction to 130 mmHg. Generalizability to other populations was assessed in CAD patients from REACH North America and Western Europe (n = 25,812). RESULTS: Median 10-year ARR from low-dose colchicine was 4.6% (interquartile range [IQR] 3.6-6.0%) for MACE, and 8.6% (IQR 7.6-9.8%) for MACE + . Lifetime benefit was 2.0 (IQR 1.6-2.5) MACE-free years, and 3.4 (IQR 2.6-4.2) MACE + -free life-years gained. For LDL-c and SBP reduction respectively, median 10-year ARR for MACE was 3.0% (IQR 1.5-5.1%) and 1.7% (IQR 0.0-5.7%), and lifetime benefit was 1.2 (IQR 0.6-2.1) and 0.7 (IQR 0.0-2.3) MACE-free life-years gained. Similar results were obtained for MACE+, and in American and European patients from REACH. CONCLUSIONS: The absolute benefits of low-dose colchicine vary between individual patients with chronic CAD. They may be expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in a majority of patients already on conventional lipid-lowering and blood pressure-lowering therapy.

Type: Article
Title: Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease
Location: England
DOI: 10.1093/eurjpc/zwad221
Publisher version: https://doi.org/10.1093/eurjpc/zwad221
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Cardiovascular risk prediction, Colchicine, Coronary artery disease, ESC Guidelines, Inflammation, Secondary prevention
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10173514
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