175 The efficacy and safety of low-dose colchicine in patients with coronary disease VISUAL ABSTRACT Myocardial infarction Colchicine in Coronary Disease RR 0.78 (95% CI 0.64 to 0.94) RR 0.54 (95% CI 0.34 to 0.86) RR 0.77 (95% CI 0.66 to 0.90) A meta-analysis of 5 studies Colchicine 0.5 mg 4.2% 250/5806 Pooled relative risk reduction 25% (RR 0.75, 95% CI 0.61 to 0.92) MACE Myocardial infarction, stroke, or cardiovascular death Placebo or no colchicine 5.7% 328/5788 RR 0.82 (95% CI 0.55 to 1.23) No significant relative risk reduction Inflammasome Caspase-1 Pro-IL-1β IL-1β 1 Inhibiting inflammasome activation 2 Inhibiting neutrophil chemotaxis, adhesion and activation 3 Inhibiting neutrophil-platelet interaction Crytalloids Potential mechanisms Stroke Coronary revascularisation Cardiovascular death Significant relative risk reduction Significant relative risk reduction Significant relative risk reduction 22% 46% 23% INTRODUCTION Despite improvements in prevention, the global burden of cardiovascular disease continues to rise.1 Guidelines recommend lifestyle changes (exercise, nutrition, smoking cessation), control of risk factors (hypertension, dyslipidaemia, dysglycaemia), and anti-thrombotic therapy in patients with coronary disease,2–4 but even when these are routinely adopted, a high residual risk remains of myocardial infarction, stroke, coronary revascularization, or cardiovascular death.5,6
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