Abstract
Background: The objective is to study whether the cardiovascular protective effects of colchicines could be applied to non-cardiogenic ischemic stroke (IS) patients. Patients and Methods: Non-cardiogenic IS patients were identified from the National Health Insurance Research Database. Eligible patients were divided into chronic and non-chronic use categories based on their long-term status of colchicine use. The non-chronic use category was subdivided into (1) non-user and (2) new user groups while the chronic use category was divided into (3) former user and (4) long-term user groups according to the patient’s recent status of colchicine use. Inverse probability of treatment weights for propensity scores was used to balance the baseline characteristics. The primary outcome was recurrent IS, which was compared within the non-chronic use and chronic use categories. Results: In the non-chronic use category, the number of patients was 355,498 and 912 in the non-user and new user groups, respectively. In the chronic use category, the number of patients was 4737 and 4354 in the former user and long-term user groups, respectively. In the non-chronic use category, patients in the new user group had a marginally lower risk of recurrent IS at 6-months (subdistribution hazard ratio [SHR], 0.95; 95% confidence interval [CI], 0.94–0.97) and 2-years (SHR, 0.92; 95% CI, 0.91–0.93) follow up. In the chronic use category, patients in the long-term user group also had a marginally lower risk of recurrent IS at 6-months (SHR, 0.87; 95% CI, 0.86–0.88) and 2-years (SHR, 0.87; 95% CI, 0.86–0.88) follow up. The effect of colchicine on the reduced risk of recurrent IS was more favorable in patients who also used statins. Conclusions: Recent colchicine use in acute non-cardiogenic IS patients is associated with marginal fewer incidences of recurrent IS. Patients with concurrent statin use may have more profound protective effects.
Highlights
Risk factor modification and antithrombotic drugs are crucial for reducing ischemic stroke (IS) recurrence [1,2]
Clinical trials have demonstrated the promising effects of high-potency atorvastatin on the prevention of secondary IS [5], and better protective effects of aggressive lipid lowering therapy on atherosclerotic stroke [6]
The Colchicine Cardiovascular Outcomes (COLCOT) and Low-Dose Colchicine (LoDoCo) trials have demonstrated that patients receiving low dose colchicine had a significantly lower risk of ischemic CV events compared with patients receiving the placebo, after acute myocardial infarction (MI) and stable coronary artery disease (CAD) [7,8]
Summary
Risk factor modification and antithrombotic drugs are crucial for reducing ischemic stroke (IS) recurrence [1,2]. The Colchicine Cardiovascular Outcomes (COLCOT) and Low-Dose Colchicine (LoDoCo) trials have demonstrated that patients receiving low dose colchicine had a significantly lower risk of ischemic CV events compared with patients receiving the placebo, after acute myocardial infarction (MI) and stable coronary artery disease (CAD) [7,8]. Recent meta-analyses have demonstrated inconclusive but potentially beneficial effects of colchicine on IS prevention These studies were limited by small sample size and heterogeneous baseline characteristics in the enrolled patients [9,10,11,12,13]. Different subtypes may have diverse underlying mechanisms, which could confound the clinical effects of study drugs This raises the question of whether recent use of colchicines is associated with fewer stroke recurrence due to its anti-inflammatory effect in patients with acute IS, and our study aimed to answer this question
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