Role of anti-inflammatory agent colchicine in atherosclerotic cardiovascular disease

Colchicine is an anti-inflammatory alkaloid that reduces cardiovascular events through its actions on the interleukin(IL)-1β/IL-6/C-reactive protein pathway, which promotes the degradation and rupture of atherosclerotic plaques. Low-dose colchicine (0.5 mg/day) has been shown to decrease major adverse cardiovascular events (MACE) by 31% among patients with stable atherosclerosis and 23% among those after a recent myocardial infarction. In patients with coronary artery disease (CAD) already taking a statin, colchicine in conjunction with lipid-lowering therapy has additionally been shown to provide a larger benefit with respect to secondary prevention of MACE. The drug is contraindicated in patients with renal or hepatic impairment and should be avoided in patients taking strong cytochrome P450 3A4 or P-glycoprotein inhibitors. Low-dose colchicine was recently approved by the United States Food and Drug Administration in 2023 to reduce the risk of stroke, coronary revascularization, myocardial infarction, and cardiovascular death among patients with atherosclerotic disease or multiple risk factors. This article focuses on the use of colchicine and its anti-inflammatory effects in preventing MACE among patients with CAD and patients without CAD with multiple risk factors.