The Use of Colchicine in Cardiovascular Disease: Anti-Inflammatory Mechanisms and Clinical Utility

Current data indicate that low-dose colchicine (0.5 mg/day) may reduce the risk of major adverse cardiovascular (CV) events (MACE) in patients with coronary artery disease and thus can become a new standard, effective, cost-efficient, and well-tolerated therapy for cardiac patients. Various important randomised controlled studies have reported on colchicine's influence on CV outcomes, and meta-analyses of these trials show that colchicine mitigates the risk of recurrent MACE by 25%, resulting in its recent approval by the Food and Drug Administration for the management and prevention of CV disease (CVD). While colchicine reduces MACE risk, its survival benefit remains inconclusive, warranting further long-term investigations. The non-significant decrease in CV death of ~20% is surpassed by a more apparent, borderline non-significant rise in the risk of non-CV death by ~40%. Main populations comprising patients with heart failure, patients submitted to surgical revascularisation, females, elderly persons, and non-Caucasians are under-represented in current trials, limiting the generalisability of such treatment. Thus, colchicine shows promise in curtailing MACE, additional data from large-scale, long-term trials are needed to corroborate such findings before its widespread use in clinical practice to favourably influence the secondary prevention of atherosclerotic CVD. Colchicine may have important advantages in curtailing myocardial infarction in specific high-risk patient groups but uncertainty about the magnitude of the impact on survival remains, particularly in the general population. Unfortunately, this agent is plagued by gastrointestinal side effects, which may deter its use. More data from larger-scale randomised studies will be required.