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

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.

The long-term benefits of treatment with low-dose colchicine were estimated for 36,642 individuals with coronary heart disease, and compared to those of lipid- and blood pressure-lowering therapy. On average, low-dose colchicine was estimated to lower the risk of cardiovascular disease in the next 10 years from 17.8% to 13.2% (a reduction of 4.6 percentage points), and to afford 2.0 additional years of life without cardiovascular disease.Low-dose colchicine was estimated to be the most effective treatment in 49%, intensive blood pressure-lowering therapy in 28%, and intensive lipid-lowering therapy in 23% of patients.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [e-mail].