d'Entremont Marc-André, Poorthuis Michiel H F, Fiolet Aernoud T L, Amarenco Pierre, Boczar Kevin Emery, Buysschaert Ian, Chan Noel C, Cornel Jan H, Jannink Jalina, Jansen Shirley, Kedev Sasko, Keech Anthony C, Layland Jamie, Mewton Nathan, Montalescot Gilles, Pascual-Figal Domingo A, Rodriguez Alfredo E, Shah Binita, Teraa Martin, van Zelm Aimee, Wang Yongjun, Mosterd Arend, Kelly Peter, Eikelboom John, Jolly Sanjit S
Population Health Research Institute, 237 Barton Street East, Hamilton L8L 2X2, Ontario, Canada.
Department of Cardiology, Hamilton General Hospital, McMaster University, 237 Barton Street East, Hamilton L8L 2X2, Ontario, Canada.
Eur Heart J. 2025 Jul 7;46(26):2564-2575. doi: 10.1093/eurheartj/ehaf210.
Randomized trials of colchicine in secondary prevention of atherosclerotic cardiovascular disease have shown mixed results.
A systematic review and study-level meta-analysis of randomized controlled trials was performed comparing colchicine vs no colchicine in a secondary-prevention atherosclerotic cardiovascular disease population. A fixed-effect inverse variance model was applied using the intention-to-treat population from the included trials. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke.
Nine trials, including 30 659 patients (colchicine 15 255, no colchicine 15 404) with known coronary artery disease or stroke, were included. Compared with no colchicine, patients randomized to colchicine had a relative risk (RR) of 0.88 [95% confidence interval (CI) 0.81-0.95, P = .002] for the primary composite outcome, including a RR of 0.94 for cardiovascular death (95% CI 0.78-1.13, P = .5), a RR of 0.84 for myocardial infarction (95% CI 0.73-0.97, P = .016), and a RR of 0.90 for stroke (95% CI 0.80-1.02, P = .09). Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10-1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death.
In patients with prior coronary disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12%.
秋水仙碱用于动脉粥样硬化性心血管疾病二级预防的随机试验结果不一。
对随机对照试验进行系统评价和研究水平的荟萃分析，比较秋水仙碱与非秋水仙碱在动脉粥样硬化性心血管疾病二级预防人群中的效果。采用固定效应逆方差模型，纳入试验中的意向性治疗人群。主要结局为心血管死亡、心肌梗死或中风的复合结局。
纳入9项试验，共30659例已知患有冠状动脉疾病或中风的患者（秋水仙碱组15255例，非秋水仙碱组15404例）。与非秋水仙碱组相比，随机分配至秋水仙碱组的患者主要复合结局的相对风险（RR）为0.88[95%置信区间（CI）0.81 - 0.95，P = 0.002]，其中心血管死亡的RR为0.94（95%CI 0.78 - 1.13，P = 0.5），心肌梗死的RR为0.84（95%CI 0.73 - 0.97，P = 0.016），中风的RR为0.90（95%CI 0.80 - 1.02，P = 0.09）。秋水仙碱与胃肠道事件住院的RR为1.35（95%CI 1.10 - 1.66，P = 0.004）相关，肺炎、新诊断癌症或非心血管死亡的住院率无增加。
在既往有冠心病或中风的患者中，秋水仙碱使心血管死亡、心肌梗死或中风的复合结局降低了12%。
