Ballacci Federico, Giordano Federica, Conte Cristina, Telesca Alessandro, Collini Valentino, Imazio Massimo
Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine.
Department of Medicine, University of Udine, Udine, Italy.
J Cardiovasc Med (Hagerstown). 2025 Jul 1;26(7):359-368. doi: 10.2459/JCM.0000000000001744. Epub 2025 Jun 5.
Inflammation is a main pathophysiological driver in atherosclerotic cardiovascular diseases (ASCVD). Low-dose long-term colchicine for secondary prevention in patients with established ASCVD has been studied in multiple randomized trials in the last decade.This meta-analysis aimed to evaluate the efficacy and safety of long-term low-dose colchicine for secondary prevention in patients with established ASCVD.
We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate studies reporting long-term outcomes in patients with ASCVD. We systematically searched PubMed, EMBASE and Scopus databases for relevant studies up to 1 December 2024. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), a composite of cardiovascular death (CVD), myocardial infarction (MI) and stroke. Random-effects models were used to calculate pooled risk ratios (RRs).
Ten randomized clinical trials enrolling 22 532 patients were identified. Addition of colchicine to standard medical treatment in patients with established ASCVD reduced the risk for MACE by 27% [RR 0.73, 95% confidence interval (CI) 0.57-0.95], with a number needed to treat of 52. Colchicine was found to significantly reduce the risk of MI (RR 0.83, 95% CI 0.72-0.96) and coronary revascularization (RR 0.79, 95% CI 0.65-0.94). There were no significant differences between the two groups concerning cardiovascular and noncardiovascular mortality, risk of serious gastrointestinal events, infections requiring hospitalization and cancer.
These findings support the use of long-term low-dose colchicine for secondary prevention of MACE in clinical practice.
炎症是动脉粥样硬化性心血管疾病（ASCVD）的主要病理生理驱动因素。在过去十年中，多项随机试验对低剂量长期使用秋水仙碱用于已确诊ASCVD患者的二级预防进行了研究。本荟萃分析旨在评估长期低剂量秋水仙碱用于已确诊ASCVD患者二级预防的疗效和安全性。
我们按照PRISMA指南进行了系统评价和荟萃分析，以评估报告ASCVD患者长期结局的研究。我们系统检索了截至2024年12月1日的PubMed、EMBASE和Scopus数据库中的相关研究。主要结局是主要不良心血管事件（MACE）的发生，MACE是心血管死亡（CVD）、心肌梗死（MI）和中风的复合指标。采用随机效应模型计算合并风险比（RRs）。
共纳入10项随机临床试验，涉及22532例患者。在已确诊ASCVD的患者中，在标准药物治疗基础上加用秋水仙碱可使MACE风险降低27%[RR 0.73，95%置信区间（CI）0.57 - 0.95]，需治疗人数为52。发现秋水仙碱可显著降低MI风险（RR 0.83，95% CI 0.72 - 0.96）和冠状动脉血运重建风险（RR 0.79，95% CI 0.65 - 0.94）。两组在心血管和非心血管死亡率、严重胃肠道事件风险、需要住院治疗的感染和癌症方面无显著差异。
这些发现支持在临床实践中使用长期低剂量秋水仙碱进行MACE的二级预防。
