Colchicine in cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials

Residual inflammatory risk contributes to recurrent cardiovascular events despite optimal medical therapy. Colchicine has been evaluated in multiple randomized controlled trials (RCTs) across diverse cardiovascular settings; however, results regarding efficacy and safety have been variable. This meta-analysis aimed to comprehensively assess the impact of colchicine on cardiovascular efficacy outcomes and adverse events (AEs) in adult patients with high cardiovascular risk or established cardiovascular disease.

PubMed, Embase, Cochrane CENTRAL, and Web of Science were systematically searched from inception to August 29, 2024. RCTs comparing colchicine with placebo or standard therapy were included. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) were pooled using random-effects models. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated with GRADE.

Thirty-nine RCTs including 37,812 participants were analyzed. Colchicine reduced acute myocardial infarction (RR=0.81, 95% CI 0.71-0.92), atrial fibrillation (RR=0.74, 95% CI 0.66-0.84), pericarditis (RR=0.48, 95% CI 0.39-0.59), acute coronary syndrome (RR=0.39, 95% CI 0.23-0.65), and hospitalization (RR=0.52, 95% CI 0.38-0.70). No reduction was observed for all-cause mortality. The certainty of evidence was high for all assessed outcomes according to GRADE. Gastrointestinal AEs were more frequent, particularly at higher doses, without an increase in serious AEs.

Colchicine reduces recurrent cardiovascular events with an acceptable safety profile but does not affect all-cause mortality.