Aernoud Fiolet

163 Reply. Colchicine in Patients with Chronic Coronary Disease TO THE EDITOR (1) I n their report on a trial of low-dose colchicine (LoDoCo2) in patients with chronic coronary disease, Nidorf et al. (Nov. 5 issue) 1 found that those who received colchicine had a 31% lower risk of adverse cardiovascular events than those who received placebo (hazard ratio, 0.69; 95% confidence interval [CI], 0.57 to 0.83). This finding supports the role of inflammation as a key mediator in the development of cardiovascular disease. Inoneprespecifiedsubgroupanalysis,wenoticedan interesting interactionshowing a greater treatment effect among the patients in Australia than among those in the Netherlands (hazard ratios of 0.51 and 0.92, respectively).According to the baseline characteristics of these groups as stratified by location, some key differences in the Netherlands population include a higher incidence of smoking (15.7% vs. 4.2%), a higher incidence of stage 3a chronic kidney disease (7.9% vs. 1.1%), and a greater use of anticoagulants (14.3% vs. 8.1%) (Table S4 in the Supplementary Appendix of the article, available at NEJM.org ). Further investigation may be warranted to determine whether these differing characteristics between trial populations had any effect on outcomes. If so, the presence of such factors could influence the decision to administer colchicine for reducing cardiovascular events in patients with chronic coronary disease. David Kaiser, M.D., Christopher D. Jackson, M.D. University of Tennessee Health Science Center, Memphis, TN REFERENCES 1. Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in patients with chronic coronary disease. N Engl J Med 2020;383:1838-1847.