Potential Impact of Colchicine on Atherosclerotic Cardiovascular Disease in the United States

In the COLCOT (Colchicine Cardiovascular Outcomes Trial) and LoDoCo2 (Low-Dose Colchicine 2) coronary artery disease trials, low-dose colchicine decreased the risk of major adverse cardiovascular events (MACEs) by 23% to 31% beyond statin therapy with a strong safety profile. The number of MACE potentially preventable by widespread colchicine use in the United States remains uncertain.

The objective of this study was to estimate the current and potential impact of colchicine on cardiovascular outcomes.

We first calculated the number of new colchicine users with coronary artery disease before and after COLCOT and LoDoCo2 publication at an integrated health care system in southeastern New England from 2018 to 2023. Second, we estimated the number of potentially avoidable MACEs with widespread colchicine use using incidence rates and the relative risk reduction from the LoDoCo2 trial and the nationally representative National Health And Nutrition Examination Survey study.

From January 2018 to December 2019 (before COLCOT and LoDoCo2 publication), the number of new colchicine users varied between 126 and 151 every 6 months. From January 2020 to June 2023, the number of new colchicine users increased from 141 to 181 every 6 months (<1% of adults with coronary artery disease at Mass General Brigham). Among the estimated 9.2 million adults with stable coronary artery disease on a statin in the United States, adding colchicine to standard medical management is estimated to prevent 226,000 MACE over a 3-year period.

Adding colchicine to standard cardiovascular management may prevent 226,000 MACE in the United States over a 3-year period.