Highlights from

AHA 2019

American Heart Association’s Scientific Sessions

Philadelphia, USA 16 - 18 November 2019

Colchicine Prevents Cardiovascular Events

Low-dose colchicine, an anti-inflammatory indicated for gout and pericarditis, can prevent major adverse cardiovascular (CV) events compared with placebo. The benefit was primarily due to a reduction in the incidence of stroke and urgent hospitalisation for unstable angina leading to revascularisation in patients with recent history of myocardial infarction (MI), according to the randomised COLCOT trial.

Prof. Jean-Claude Tardif (University of Montreal, Canada) presented this study [1], and reminded the audience that while the previous LoDoCo trial showed that 5 mg colchicine reduced the risk of CV events in the setting of stable coronary artery disease, it only enrolled 532 patients and did not involve a placebo. By contrast, COLCOT randomised 4,745 patients (mean age 60.6 years; 19.2% female) in 12 countries to low-dose colchicine (0.5 mg once daily) or placebo. Patients enrolled at a mean of 13.5 days after MI. Patient characteristics in both groups were similar.

The primary efficacy endpoint consisted of death from CV causes, resuscitated cardiac arrest, MI, stroke, or urgent rehospitalisation for angina leading to coronary revascularisation. The intention-to-treat analysis at a median follow-up of 22.6 months demonstrated that the patients in the colchicine group were at significantly lower risk of experiencing a primary-endpoint event than were those who received placebo (5.5% vs 7.1%; HR 0.77; 95% CI 0.61-0.96), which was simultaneously published in the New England Journal of Medicine [2].

There were no significant decreases between the 2 study arms for the individual components of CV death, resuscitated cardiac arrest, or MI. However, the drug did lower the risk of stroke (HR 0.26; 95% CI 0.10-0.70) and urgent hospitalisation for angina leading to coronary revascularisation (HR 0.50; 95% CI 0.31-0.81).

Drug discontinuation did not differ between colchicine and placebo users. Serious adverse events were equally common overall between the 2 study arms, though pneumonia was more common with colchicine than with placebo (0.9% vs 0.4%; P=0.03). Diarrhoea was similar in the 2 groups. Patients in the colchicine group were more likely to experience nausea (1.8% vs 1.0%; P=0.02). The wide access and affordability of colchicine makes this study of particular importance.

  1. Tardif J-C, et al. The COLchicine Cardiovascular Outcomes Trial (COLCOT). Session LBS01. American Heart Association Annual Scientific Sessions (AHA 2019), 14-18 November, Philadelphia, PA, USA.
  2. Tardif J-C, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019 [Epub ahead of print].

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The content and interpretation of these conference highlights are the views and comments of the speakers/authors.