Mohammadnia Niekbachsh, Wesselink Britta E, Bax Willem A, Nidorf Stefan M, Mosterd Arend, Fiolet Aernoud T L, Cetinyurek-Yavuz Aysun, Thompson Peter L, Bangdiwala Shrikant I, Eikelboom John W, Cornel Jan H, El Messaoudi Saloua
Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.
Department of Internal Medicine Northwest Clinics Alkmaar Netherlands.
J Am Heart Assoc. 2025 May 20;14(10):e038687. doi: 10.1161/JAHA.124.038687. Epub 2025 May 15.
The LoDoCo2 (Low-Dose Colchicine 2) trial showed that colchicine reduced the risk for cardiovascular events in patients with chronic coronary syndrome. Current guidelines recommend colchicine use in selected high-risk patients. The aim of this secondary analysis was to explore the relative and absolute benefits of colchicine according to baseline risk.
The LoDoCo2 trial randomized 5522 patients to colchicine 0.5 mg or placebo. The primary end point was a composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. First, a LoDoCo2 risk score was developed by Cox regression to identify high-risk features for the primary end point. Second, the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was applied to explore robustness of findings.
In the LoDoCo2 risk score, high-risk features were age ≥75, diabetes, and current smoker. In high-risk (≥1 high-risk feature), compared with low-risk (0 high-risk features) patients, colchicine was associated with consistent relative (high risk: hazard ratio [HR], 0.72 [95% CI, 0.56-0.94] versus low risk: HR, 0.67 [95% CI, 0.52-0.88]; for interaction=0.73) and absolute benefits (high risk: HR, -1.33 [95% CI, -2.38 to -0.27] versus low risk: HR, -0.93 [95% CI -1.57 to -0.30] events per 100 person-years). Using the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, consistent relative and absolute benefits were found in high-, intermediate-, and low-risk patients.
In patients with chronic coronary syndrome, the relative and absolute benefits of colchicine were consistent in those at high, intermediate, and low risk for cardiovascular events. These findings support the use of colchicine across the spectrum of baseline risk.
URL: https://www.anzctr.org.au; Unique identifier: 12614000093684.
LoDoCo2（低剂量秋水仙碱2）试验表明，秋水仙碱可降低慢性冠状动脉综合征患者发生心血管事件的风险。当前指南推荐在部分高危患者中使用秋水仙碱。这项二次分析的目的是根据基线风险探讨秋水仙碱的相对和绝对获益。
LoDoCo2试验将5522例患者随机分为0.5毫克秋水仙碱组或安慰剂组。主要终点是心血管死亡、自发性心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建的复合终点。首先，通过Cox回归制定LoDoCo2风险评分，以识别主要终点的高危特征。其次，应用心肌梗死二级预防溶栓风险评分来探讨研究结果的稳健性。
在LoDoCo2风险评分中，高危特征为年龄≥75岁、糖尿病和当前吸烟者。在高危（≥1个高危特征）患者中，与低危（0个高危特征）患者相比，秋水仙碱具有一致的相对获益（高危：风险比[HR]，0.72[95%CI，0.56 - 0.94]，低危：HR，0.67[95%CI，0.52 - 0.88]；交互作用P = 0.73）和绝对获益（高危：HR，-1.33[95%CI，-2.38至-0.27]，低危：HR，-0.93[95%CI，-1.57至-0.30]事件/每100人年）。使用心肌梗死二级预防溶栓风险评分，在高危、中危和低危患者中均发现了一致的相对和绝对获益。
在慢性冠状动脉综合征患者中，秋水仙碱在心血管事件高危、中危和低危患者中的相对和绝对获益是一致的。这些发现支持在整个基线风险范围内使用秋水仙碱。
Zotero 插件