Aernoud Fiolet

167 Reply. Colchicine in Patients with Chronic Coronary Disease TO THE EDITOR (4) In the LoDoCo2 trial, patients with chronic coronary disease who received colchicine had a lower risk of cardiovascular events than those who received placebo but did not have a corresponding lower risk of death. Clonal hematopoiesis of indeterminate potential (CHIP; the presence of leukemia-associated gene mutations inpatientswithout detectable hematologic cancer) increases in incidence with age, and clones that consist of at least 10% of circulating nucleated cells are found in 10 to 15% of adults who are older than 70 years of age. 1 CHIP is associated with increased cardiovascular morbidity and mortality owing to accelerated atherosclerosis caused by proinflammatory interactions between endothelium and clonal monocytes (mediated by the NLRP3 inflammasome). 2,3 Since colchicine has been shown to suppress the activation of the NLRP3 inflammasome and the production of interleukin-1 β in circulating monocytes in patients with acute coronary syndrome, 4 it may be especially beneficial in patients with CHIP. Thus, it would be of great interest if the authors could test for the presence of the CHIP mutations in at least a subgroup of patients and analyze whether an interaction exists among the receipt of colchicine, the presence of CHIP, and clinical outcomes. Marko Lucijanic, M.D., Ph.D. University Hospital Dubrava, Zagreb, Croatia Eugen Javor, M.Pharm. General Hospital Bjelovar, Bjelovar, Croatia Marko Skelin, M.Pharm., Ph.D.General Hospital Sibenik, Sibenik, Croatia REFERENCES 1. Jaiswal S, Fontanillas P, Flannick J, et al. Age-related clonal hematopoiesis associated with adverse outcomes. N Engl J Med 2014;371:2488-2498. 2. Steensma DP. Clinical consequences of clonal hematopoiesis of indeterminate potential. Blood Adv 2018;2:3404-3410. 3. FusterJJ,MacLauchlan S, ZuriagaMA, et al. Clonal hematopoiesis associatedwithTET2 deficiency accelerates atherosclerosis development in mice. Science 2017;355:842-847. 4. Robertson S, Martínez GJ, Payet CA, et al. Colchicine therapy in acute coronary syndrome patients acts on caspase-1 to suppress NLRP3 inflammasome monocyte activation. Clin Sci (Lond) 2016;130:1237-1246.