Meta-analysis: Colchicine reduces MACE by 17%, eMACE by 23% in ASCVD

This systematic review and meta-analysis evaluated the efficacy and safety of low-dose colchicine in atherosclerotic cardiovascular disease (ASCVD). The analysis included 11 randomized controlled trials (after one trial with zero endpoint events in both arms was excluded) with a total of 30,808 participants and 1,983 primary endpoint events. The primary endpoint was major adverse cardiovascular events (MACE), a composite of myocardial infarction (MI), stroke, and cardiovascular death. The key secondary endpoint was extended MACE (eMACE), defined as MACE plus coronary revascularization. Pooled estimates were calculated using a random-effects model and presented as risk ratios (RR) with 95% confidence intervals (CI). Colchicine was associated with a statistically significant 17% reduction in the incidence of MACE (RR 0.83, 95% CI 0.73 to 0.95; P = 0.006) and a 23% reduction in the incidence of eMACE (RR 0.77, 95% CI 0.63 to 0.94; P = 0.01). This reduction was driven by a lower rate of MI (RR 0.78, 95% CI 0.63 to 0.95; P = 0.02) and coronary revascularization (RR 0.73, 95% CI 0.55 to 0.97; P = 0.03). There were numerically fewer strokes in the colchicine-treated population, but this was not statistically significant (RR 0.81, 95% CI 0.63 to 1.04; P = 0.11). Colchicine had no statistically significant effect on cardiovascular mortality (RR 0.96, 95% CI 0.79 to 1.15; P = 0.64) or non-cardiovascular mortality (RR 1.04, 95% CI 0.76 to 1.41; P = 0.81). The authors conclude that colchicine reduces the risk of non-fatal ischemic events in patients with ASCVD and note that further studies are required to identify the population(s) who stand to benefit most.

If you have heart disease from clogged arteries, you know the constant worry about having another heart attack or needing another stent or bypass surgery. A new review of 11 major trials looked at whether adding a low dose of an old anti-inflammatory drug called colchicine could help. The analysis, which included data from over 30,000 people, found that colchicine was linked to a lower risk of major heart problems like heart attacks and strokes. Specifically, it reduced the overall risk of major heart events by 17% and the risk of events that also included procedures to open arteries by 23%. The benefit seemed to come mostly from preventing non-fatal events: it lowered the chance of having a heart attack and needing a coronary procedure. However, it did not reduce the risk of dying from heart disease or from other causes. The researchers conclude that colchicine reduces the risk of non-fatal events in people with heart disease, but more work is needed to figure out exactly which patients might benefit the most from adding it to their treatment plan.