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Colchicine in coronary heart disease: from inflammatory biology to secondary prevention

Massimo Imazio1

  • 1Department of Medicine, University of Udine, and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy. massimo.imazio@uniud.it.

Clinical and Experimental Rheumatology
|July 15, 2026
PubMed

Insights

Colchicine, an anti-inflammatory drug, offers a low-cost option for secondary cardiovascular prevention. It reduces major adverse cardiovascular events in patients with coronary heart disease, though mortality benefits are inconsistent.

Area of Science:

  • Cardiology
  • Inflammation Research
  • Pharmacology

Background:

  • Inflammation plays a key role in atherosclerosis and its complications.
  • Current coronary heart disease management focuses on lipid lowering and antithrombotic therapy.
  • Targeting inflammation is a new therapeutic avenue for cardiovascular prevention.

Purpose of the Study:

  • To review the role of colchicine in cardiovascular prevention.
  • To summarize evidence for colchicine's efficacy and safety in coronary heart disease.
  • To discuss the practical application of colchicine for secondary prevention.

Main Methods:

  • Review of biological rationale for colchicine in cardiovascular disease.
  • Analysis of randomized controlled trials (e.g., CANTOS, COLCOT, LoDoCo2) and meta-analyses.
  • Assessment of colchicine's safety profile and adverse effects.

Main Results:

  • Colchicine trials demonstrate reductions in major adverse cardiovascular events, myocardial infarction, stroke, and coronary revascularization.
  • Benefits are observed independently of lipid-lowering effects.
  • Gastrointestinal intolerance is the most common adverse effect; mortality reduction is not consistently observed.

Conclusions:

  • Colchicine is a viable, low-cost anti-inflammatory option for secondary prevention in coronary heart disease, particularly in chronic coronary syndromes.
  • It offers an adjunctive strategy beyond traditional therapies.
  • Further research may clarify its role in mortality reduction and optimal patient selection.

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