Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease
Author:
Burger Pascal M1ORCID, Dorresteijn Jannick A N1ORCID, Fiolet Aernoud T L23, Koudstaal Stefan34ORCID, Eikelboom John W5ORCID, Nidorf Stefan M67ORCID, Thompson Peter L67, Cornel Jan H38ORCID, Budgeon Charley A9ORCID, Westendorp Iris C D10ORCID, Beelen Driek P W11, Martens Fabrice M A C312ORCID, Steg Philippe Gabriel13, Asselbergs Folkert W2ORCID, Cramer Maarten J2ORCID, Teraa Martin14ORCID, Bhatt Deepak L15ORCID, Visseren Frank L J1ORCID, Mosterd Arend316ORCID, Nidorf S M, Xu X F, Ireland M A, Latchem D, Whelan A, Hendriks R, Salkani P, Tan I W, Thompson A G, Morton A M, Hockings B E, Thompson P L, King B, Cornel J H, Bakker-Lohmeijer H, Mosterd A, Bunschoten P, The S H K, van der Kooi S, Lenderink T, Lardinois R G J L, Hoogslag P A M, de Vos A, Jerzewski A, Jansen S, Nierop P R, van der Knaap M, Swart H P, Kingma R, Schaap J, Blom L B, Kuijper A F M, Bayraktar-Verver E, van Hessen M W J, Engelen W C T C, van Eck J W M, van der Ven-Elzebroek N, van Hal J M C, Drost I M J, den Hartog F R, van Wijk D, van Beek E, van der Horst C, Bartels L, Hendriks M, de Nooijer C, Welten C, Ronner E, Dijkshoorn A, Prins F J, Rutten R N A, Beele D P W, Hendriks I, van der Sluis A, Badings E A, Westendorp I C D, Melein A, Römer Tj J, Bruines P, van de Wal R, Leenders - van Lieshout I, Hemels M E W, Meinen-Werner K, de Groot M R, Post G, Mulder M W C, Stuij S, van Nes E, Luyten P, Plomp J, Veldmeijer S V, Asselman M J, Scholtus P A, Asselbergs F W, Cramer M J, van der Meer M G, Nathoe H M, de Borst G J, Bots M L, Emmelot-Vonk M H, de Jong P A, Lely A T, van der Kaaij N P, Kappelle L J, Ruigrok Y M, Verhaar M C, Visseren F L J, Dorresteijn J A N, Bhatt D L, Steg P G, Ohman E M, Röther J, Wilson P W F, Alberts M J, Bhatt D L, D’Agostino R, Eagle K A, Goto S, Hirsch A T, Liau C S, Mas J L, Ohman E M, Röther J, Smith S C, Steg P G, Wilson P W F, , ,
Affiliation:
1. Department of Vascular Medicine, University Medical Centre Utrecht , Utrecht , The Netherlands 2. Department of Cardiology, University Medical Centre Utrecht , Utrecht , The Netherlands 3. Dutch Cardiovascular Research Network (WCN) , Moreelsepark 1, 3511 EP Utrecht , The Netherlands 4. Department of Cardiology, Green Heart Hospital , Gouda , The Netherlands 5. Department of Medicine, McMaster University , Hamilton , Canada 6. Department of Cardiology, GenesisCare Western Australia , Perth , Australia 7. Heart Research Institute of Western Australia , Perth , Australia 8. Department of Cardiology, Radboud University Medical Centre , Nijmegen , The Netherlands 9. School of Population and Global Health, University of Western Australia , Perth , Australia 10. Department of Cardiology, Red Cross Hospital , Beverwijk , The Netherlands 11. Department of Cardiology, IJsselland Hospital , Capelle aan den IJssel , The Netherlands 12. Department of Cardiology, Deventer Hospital , Deventer , The Netherlands 13. Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris , Paris , France 14. Department of Vascular Surgery, University Medical Centre Utrecht , Utrecht , The Netherlands 15. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System , New York , USA 16. Department of Cardiology, Meander Medical Centre , Maatweg 3, 3813 TZ Amersfoort , The Netherlands
Abstract
Abstract
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 individual absolute benefits from low-dose colchicine according to patient risk profile.
Methods and results
The European Society of Cardiology (ESC) guideline–recommended SMART-REACH model was combined with the relative treatment effect of low-dose colchicine and applied to patients with CAD from the Low-Dose Colchicine 2 (LoDoCo2) trial and the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease (UCC-SMART) study (n = 10 830). Individual treatment benefits were 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 REduction of Atherothrombosis for Continued Health (REACH) registry. Colchicine was compared with other ESC guideline–recommended intensified (Step 2) prevention strategies, i.e. LDL cholesterol (LDL-c) reduction to 1.4 mmol/L and systolic blood pressure (SBP) reduction to 130 mmHg. The generalizability to other populations was assessed in patients with CAD from REACH North America and Western Europe (n = 25 812). The 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, the median 10-year ARR for MACE was 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%), and the 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.
Conclusion
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.
Funder
National Health Medical Research Council Sanofi-Aventis Bristol-Myers Squibb
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Epidemiology
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|