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Cardiovascular Outcomes with Colchicine in Coronary Artery Disease and HFpEF: A Propensity-Matched TriNetX Analysis
Faizan Ahmed1, Saifullah Khan2, Madeeha Shafqat3
1Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA.
Insights
Colchicine use in patients with coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF) was linked to reduced cardiovascular events and mortality in real-world data. These benefits showed some decrease over time, warranting further investigation.
Area of Science:
- Cardiology
- Pharmacology
- Inflammation Research
Background:
- Coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF) are leading causes of death.
- Systemic inflammation is implicated in both CAD and HFpEF.
- Limited data exist on colchicine's efficacy in patients with both CAD and HFpEF.
Purpose of the Study:
- To evaluate the real-world effectiveness of colchicine in patients diagnosed with both CAD and HFpEF.
- To assess the impact of colchicine on major adverse cardiovascular events and mortality in this patient population.
Main Methods:
- A large-scale, real-world study using the TriNetX Research Network.
- Identified 480,434 adults with CAD and HFpEF, comparing colchicine users (n=30,254) with non-users (n=450,180).
- Propensity score matching created comparable groups (28,941 per group) to analyze primary outcomes (composite of MI, stroke, mortality, acute HF) and secondary outcomes at 1 and 3 years.
Main Results:
- Colchicine use was associated with a reduced risk of the primary composite outcome at 1 year (16.9% vs 19.8%) and 3 years (34.2% vs 39.7%).
- All-cause mortality was significantly lower in the colchicine group at 1 year (11.4% vs 14.5%).
- Stroke risk was modestly reduced, but acute heart failure risk was slightly higher at 3 years; no differences in hospitalizations, atrial fibrillation, or GI events were observed.
Conclusions:
- Colchicine demonstrated a lower short- and medium-term risk of composite cardiovascular events and mortality in patients with CAD and HFpEF.
- The observed benefits showed some attenuation over time, suggesting an early, time-dependent effect.
- Further prospective randomized trials are recommended to confirm these findings.
Background:
Coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF) are major causes of morbidity and mortality. Systemic inflammation contributes to both, suggesting potential benefit from colchicine, though data in CAD-HFpEF are limited.
Methods:
We conducted a real-world study using the TriNetX Research Network, identifying 480,434 adults with CAD and HFpEF. Patients were categorized as colchicine users (n = 30,254) or non-users (n = 450,180). One-to-one propensity score matching yielded 28,941 patients per group. The primary outcome was a composite of acute myocardial infarction, stroke, all-cause mortality, and acute heart failure. Secondary outcomes included individual components, hospitalizations, atrial fibrillation, and gastrointestinal events, assessed at 1- and 3-year follow-up.
Results:
At 1 year, the primary outcome occurred in 16.9% of the colchicine group versus 19.8% of non-users (HR: 0.86, 95% CI: 0.81-0.91; p < 0.001). All-cause mortality was 11.4% versus 14.5% (HR: 0.77, 95% CI: 0.73-0.80; p < 0.001). At 3 years, the primary outcome occurred in 34.2% versus 39.7% (HR: 0.88, 95% CI: 0.85-0.92; p < 0.001), with acute heart failure slightly higher in the colchicine group (27.5% vs. 26.5%; HR: 1.04, 95% CI: 1.01-1.08; p = 0.009). Stroke was modestly reduced (HR: 0.93, 95% CI: 0.88-0.99; p = 0.014). No significant differences were seen in all-cause hospitalization, atrial fibrillation, or gastrointestinal events.
Conclusions:
In patients with CAD and HFpEF, colchicine was associated with lower short- and medium-term risk of composite cardiovascular events and mortality, with modest attenuation over time, suggesting early time-dependent association rather than sustained structural effects. Prospective randomized trials are warranted.
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