Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients

Background

Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.

Purpose

This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.

Methods

The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to <1.4 mmol/L, and systolic blood pressure (SBP) reduction to <130 mmHg.

Results

Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.

Conclusion

The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.

Funding Acknowledgement

Type of funding sources: None.

Inflammation and risk of recurrent cardiovascular events according to prior vascular disease location

Background

In recent years, anti-inflammatory drugs have been shown to reduce the risk of recurrent cardiovascular disease (CVD) events in patients with coronary artery disease (CAD), but have not yet been tested in patients with other vascular disease locations. Whether the relation between inflammation and recurrent CVD is modified by prior vascular disease location is unknown.

Purpose

This study aimed to establish the relation between low-grade inflammation and recurrent CVD according to prior vascular disease location.

Methods

Inflammation was measured by plasma concentrations of high-sensitivity C-reactive protein (CRP). Patients from the UCC-SMART cohort with CAD (n=4,517), cerebrovascular disease (CeVD; n=2,154), peripheral artery disease (PAD, n=1,154), or abdominal aortic aneurysm (AAA, n=424), and CRP ≤10 mg/L were included in the main analysis (combined n=8,249). Patients with CRP >10 mg/L (n=756) were analysed separately. The primary outcome was a composite of myocardial infarction, ischemic stroke, or cardiovascular death. Secondary outcomes included the primary outcome components, major adverse limb events (MALE), and all-cause mortality. The relation between CRP and outcomes was assessed using Cox proportional hazard models stratified by prior vascular disease location, and adjusted for potential confounders.

Results

During a median follow-up of 9.5 years (interquartile range 5.1–13.9) 1,877 CVD events, 887 MALE events, and 2,341 deaths were observed. In the total population, CRP was related to recurrent CVD (hazard ratio [HR] per 1 mg/L 1.08; 95% confidence interval [CI] 1.05–1.10), and all secondary outcomes except for ischemic stroke (HR 1.03; 95% CI 0.99–1.08). Compared to the first quintile of CRP, HRs for recurrent CVD were 1.66 (95% CI 1.41–1.96) for the last quintile ≤10 mg/L, and 1.97 (95% CI 1.64–2.36) for the subgroup with CRP >10 mg/L. CRP was related to recurrent CVD in patients with CAD (HR per 1 mg/L 1.08; 95% CI 1.04–1.11), as well as CeVD (HR 1.05; 95% CI 1.01–1.10), PAD (HR 1.08; 95% CI 1.03–1.13), and AAA (HR 1.08; 95% CI 1.01–1.15; p for interaction 0.815). The relation between CRP and all-cause mortality was stronger for patients with CAD (HR 1.13; 95% CI 1.09–1.16) compared to other locations (HRs 1.06–1.08; p=0.002).

Conclusion

Inflammation is an independent risk factor of recurrent CVD and mortality, irrespective of prior vascular disease location. Trials of anti-inflammatory drugs in patients with CeVD, PAD, and AAA are warranted.

Funding Acknowledgement

Type of funding sources: None.

Effects of two glucocorticoids on milk yield and biochemical measurements in healthy and ketotic cows

The effects of two glucocorticoid compounds (Dexamedium; Intervet. Voreen; Boehringer Ingelheim) were tested in 20 healthy and 28 ketotic dairy cows. Both compounds induced an increased blood glucose concentration and a temporary decrease in the milk yield of healthy dairy cows. Dexamedium reduced the milk yield only of cows producing 25 or more kg milk daily. Of 28 ketotic cows 22 were treated with one of the two glucocorticoid compounds, while the remaining six were treated orally with propylene glycol. After treatment all but one of the cows improved clinically within one week. Biochemical analysis of blood samples revealed that after treatment with any of the three therapeutic compounds some animals responded inadequately to therapy or relapsed after initial recovery.

Clenbuterol hydrochloride in calves with a natural bovine respiratory syncytial virus infection

The effect of clenbuterol hydrochloride on the course of disease in calves with a natural bovine respiratory syncytial virus infection was examined. Six calves (three to nine months of age) originating from four herds with respiratory tract disease and serological evidence of a bovine respiratory syncytial virus infection were used in this study. The calves were injected intravenously with clenbuterol hydrochloride. The effect of clenbuterol on the course of disease was measured using the PO2 in blood taken from an indwelling canula inserted in the caudal auricular artery and by clinical signs. Clenbuterol did not improve clinical signs. After clenbuterol administration arterial PO2 values decreased significantly in five out of six patients. Six to eight hours after medication the mean arterial PO2 values were higher than initial values. The moderate positive effect of clenbuterol after six to eight hours may be caused by enhancing ciliary activity and by the secretolytic activity of clenbuterol.

Flunixin meglumine in calves with natural bovine respiratory syncytial virus infection

Twenty-three calves (three to eight months of age) with serological evidence of bovine respiratory syncytial virus infection were used in this study. The calves originated from four herds with respiratory tract disease. In a double blind trial the calves were injected intravenously with either flunixin meglumine (2 mg/kg body weight) or with a placebo. The effect on the course of disease was measured using the PO2 in capillary blood samples from the ears of the calves and by the effect on body temperature and respiratory rate. Mean body temperature fell significantly in the flunixin meglumine treated group. Statistically significant differences were not found between the treated and control group during the seven-day examination period.

Effects of trenbolone acetate and propylene glycol on pregnancy toxaemia in ewes

Eleven ewes with pregnancy toxaemia were monitored clinically and biochemically after daily treatment with trenbolone acetate (30 mg) and propylene glycol (twice daily 100 ml), for at least one week. The clinical signs of pregnancy toxaemia at first examination were less severe than those described in ewes in other countries. After the first treatment, the appetite improved in nine ewes, blood glucose levels increased in 10 ewes and blood ketone body concentrations decreased in nine animals. A statistically significant decrease in mean ketone body levels was found between the day of first examination and the second day thereafter. Four animals recovered before lambing (group 1). One animal lambed one day after the first treatment and recovered. In the remaining ewes clinical and biochemical improvement did not last long. Three of these animals did not recover until after lambing (group 2) and three animals died (group 3). In three animals of group 2 and two animals of group 3 an increase of serum activities of lactate dehydrogenase, sorbitol dehydrogenase, gamma glutamyl transferase and alkaline phosphatase was found. In two necropsied animals of group 3 a severe fatty degeneration of the liver was found. Treatment of pregnancy toxaemia with trenbolone acetate and propylene glycol appeared to have some positive effect in mild cases. In more advanced cases the time of parturition is the crucial factor leading to recovery.

[Polyarthritis in calves (author's transl)]

The development of polyarthritis was studied in thirty-six calves. Thirty patients were from two to eleven days of age; six animals were older than eleven days. Besides clinical studies, the synovial fluid was examined both biochemically and bacteriologically in addition, a blood culture was made. When the synovial fluids of twenty-six calves were studied bacteriologically, P. multocida was isolated in ten cases, P. haemolytica in two cases, E. coli in ten cases, streptococci in three cases and D. pneumoniae in one case; bacteriological examination of the synovial fluid was negative in ten cases. Blood cultures were positive in twenty animals (P. multocida in five cases, P. haemolytica in two cases, E. coli in eleven cases, S. subacidus in one case and D. pneumoniae in one case). Twenty-five calves were treated by intra-articular as well as intramuscular injection of kanamycin (sulphate); six animals were treated with similar injections of ampicillin. Treatment with ampicillin was initially instituted in five calves; after some time, however, kanamycine (sulphate) was substituted for this medication. Twenty-seven calves recovered completely.