Aernoud Fiolet

376 Chapter 15 data and longitudinal outcome data. This strongly supports the recommendation of incorporating novel data collection methods in future clinical research. A model for implementing such methods could be a stepwise approach. It can be first incorporated in “phase IV” pharmacovigilance research or with “real-world data collection.” This could then be followed by applying these data collection methods parallel or complementary to conventional data collection in “phase III” efficacy programs. Improving software algorithms will undoubtedly enhance the sensitivity of these methods. While current evidence of such data collection methods clearly reveals limitations and in certain cases may introduce the risk of bias in assessing the treatment effect, future research most certainly will benefit from these methods. CONCLUDING REMARKS This thesis aims to improve the understanding and possible modification of complex pathophysiological mechanisms in atherosclerosis. Atherosclerosis however is a disease in which biological principles are inevitably intertwined with behavioural and societal vices. With our increased lifespan, we all face the consequences of prolonged exposure to often avoidable toxins to our vascular endothelium. For this accumulating atherosclerotic burden an ingenious “protect and repair” system we dubbed the inflammatory response exists. This is the system we try to outsmart. Akin to other historical academic endeavours, in this regard “science” actually is mankind relentlessly trying to overcome a very natural response to a very unnatural threat. As always, this begs the question whether we wouldn’t be better of by avoiding the treats in the first place, rather than finding ways to cope with its consequences. Wehaveproven in this thesis that colchicine reduces the riskof major cardiovascular events in in a broad range of patients with coronary disease. We can now add an unconventional drug to our anti-atherothrombotic armamentarium. There is high level of evidence for its efficacy and its possibilities for clinical implementation should go accompanied with both mechanistic and clinical scientific interest. Simultaneously, the thesis served a methodological goal. We have demonstrated that “old” drugs can be repurposed and that the evidence to support this can be collected with the highest standard of scientific fidelity. With both feats we hope to have provided inventive methods to secure innovative medicine by “using the available to enable the sustainable”.