Aernoud Fiolet

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 anti- inflammatory 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 all- cause 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 Colchicine 1 Lipid lowering (per 1 mmol/L) 3 Blood-pressure lowering (per 10 mmHg) 5 ACE-inhibiton 6 Ticagrelor versus Clopidogrel 7 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.