Jain Hritvik, Patel Nandan, Erum Maheen, Odat Ramez M, Passey Siddhant, Khan Rozi, Jain Jyoti, Cheema Ameer Haider, Fox Sebastian, Ahmed Raheel
Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Heart Lung. 2025 Sep-Oct;73:42-47. doi: 10.1016/j.hrtlng.2025.04.022. Epub 2025 Apr 24.
Lower-extremity peripheral arterial disease (LEPAD) significantly increases the risk of severe cardiovascular and limb complications, often due to the underlying inflammation from atherosclerosis. Colchicine has gained attention due to its efficacy in the primary and secondary prevention of cardiovascular events and may offer similar protective benefits for LEPAD.
This meta-analysis aimed to evaluate outcomes with colchicine in LEPAD.
A systematic literature search was performed on the major bibliographic databases for studies until October 2024. Hazard ratios (HRs) with their corresponding 95% CIs were pooled using the inverse-variance random-effects model.
Three studies were included with 226,804 patients [113,537: Colchicine and 113,267: Placebo]. The pooled analysis demonstrates colchicine use in patients with LEPAD was associated with a significantly lower risk of major adverse limb events (MALE) [HR: 0.84; 95 % CI: 0.75, 0.94; p = 0.002], major adverse cardiovascular events (MACE) [HR: 0.90; 95 % CI: 0.82, 0.98; p = 0.02], ischemic stroke [HR: 0.97; 95 % CI: 0.94, 0.99; p = 0.02], need for major amputations [HR: 0.81, 95 % CI: 0.75, 0.87; p< 0.00001], and revascularization for lower limb ischemia [HR: 0.81; 95 % CI: 0.72, 0.90; p = 0.0001]. However, no significant reduction was noted for all-cause mortality [HR: 0.87; 95 % CI: 0.74, 1.02; p = 0.09] and myocardial infarction (MI) [HR: 0.98; 95 % CI: 0.95, 1.00; p = .10].
Colchicine may be a useful adjunctive therapy for reducing the risk of major cardiovascular and limb-related complications in patients with LEPAD, including lower rates of MACE, MALE, stroke, amputation, and limb ischemia. However, it did not significantly reduce all-cause mortality or MI. Notably, the only randomized trial evaluating colchicine's efficacy in LEPAD reported a similar risk of adverse outcomes. Multicenter, adequately powered randomized controlled trials are needed to confirm colchicine's effectiveness in this population.
下肢外周动脉疾病（LEPAD）显著增加了严重心血管和肢体并发症的风险，这通常归因于动脉粥样硬化引发的潜在炎症。秋水仙碱因其在心血管事件一级和二级预防中的功效而受到关注，并且可能对LEPAD具有类似的保护作用。
本荟萃分析旨在评估秋水仙碱治疗LEPAD的效果。
在主要文献数据库中进行了系统的文献检索，纳入截至2024年10月的研究。使用逆方差随机效应模型汇总风险比（HR）及其相应的95%置信区间。
纳入了三项研究，共226,804例患者[113,537例：秋水仙碱组和113,267例：安慰剂组]。汇总分析表明，LEPAD患者使用秋水仙碱与主要肢体不良事件（MALE）风险显著降低相关[HR：0.84；95%置信区间：0.75，0.94；p = 0.002]，主要不良心血管事件（MACE）[HR：0.90；95%置信区间：0.82，0.98；p = 0.02]，缺血性卒中[HR：0.97；95%置信区间：0.94，0.99；p = 0.02]，大截肢需求[HR：0.81，95%置信区间：0.75，0.87；p < 0.00001]，以及下肢缺血血运重建[HR：0.81；95%置信区间：0.72，0.90；p = 0.0001]。然而，全因死亡率[HR：0.87；95%置信区间：0.74，1.02；p = 0.09]和心肌梗死（MI）[HR：0.98；95%置信区间：0.95，1.00；p = 0.10]没有显著降低。
秋水仙碱可能是一种有用的辅助治疗方法，可降低LEPAD患者发生主要心血管和肢体相关并发症的风险，包括降低MACE、MALE、卒中、截肢和肢体缺血的发生率。然而，它并没有显著降低全因死亡率或MI。值得注意的是，唯一一项评估秋水仙碱在LEPAD中疗效的随机试验报告了类似的不良结局风险。需要进行多中心、有足够样本量的随机对照试验来证实秋水仙碱在该人群中的有效性。
