362 Chapter 15 risk for a cardiovascular event and a 9.4% absolute risk reduction in his lifetime risk. This translates into gaining almost 2 years of life free of major cardiovascular events.9 (Figure 1) We stand only at the beginning of translating the findings from trials of antiinflammatory therapy to clinical practice. When evaluating the role of such drugs as adjuvant in coronary disease, several questions remain to be answered, among which are the following: • How do we identify patients that will benefit the most from anti-inflammatory therapy? • What is the ideal timing of initiating anti-inflammatory treatment in a patient with coronary disease? • Will long-term anti-inflammatory treatment translate to a reduction in allcause mortality? • Do patients with atherosclerotic disease in other vascular beds benefit equally? • What is the role of alternative highly targeted anti-inflammatory drugs acting on similar pathways? Table 1. Effect size of colchicine in context: relative risk reduction on major outcomes as compared to other contemporary interventions in patients with acute or chronic coronary disease or at high risk of cardiovascular disease. Outcome Colchicine1 Lipid lowering (per 1 mmol/L)3 Blood-pressure lowering (per 10 mmHg)5 ACE-inhibiton6 Ticagrelor versus Clopidogrel7 COMPASS regime (Rivaroxaban 2.5mg + Aspirin)8 Major adverse cardiovascular event - 25% - 21% - 20% - 22% - 16% - 24% Myocardial infarction - 22% - 24% - 17% - 20% - 16% - 14% Stroke - 46% - 15% - 27% - 32% NS - 42% Revascularisation - 23% - 24% N/A - 15% N/A N/A Cardiovascular death NS - 12% N/A - 25% - 21% - 22% All cause mortality NS - 9% - 13% - 16% - 22% - 18% Number needed to treat (3 years, MACE) 40 48 N/A 45 50* 57 * The number needed to treat for 1 year. Abbreviations: ACE, angiotensin-converting enzyme. COMPASS, Cardiovascular Outcomes for People Using Anticoagulation Strategies. MACE, major adverse cardiovascular event N/A, not available. NS, not significant.
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