Chronic inflammation plays a key role in the development and progression of atherosclerotic
cardiovascular disease (ASCVD) and its complications. Despite the use of blood pressure-,
lipid- and glucose-lowering therapies as well as antithrombotic agents, the lifetime
residual cardiovascular (CV) risk in patients with ASCVD remains high. Because chronic
inflammation remains an unaddressed risk factor, anti-inflammatory therapy has the
potential to further lower residual CV risk in these patients. Low dose colchicine
(0.5 mg daily) has emerged as a promising low-cost oral anti-inflammatory therapy
for this indication.
In patients with chronic coronary syndrome (CCS), low dose colchicine was well tolerated
and reduced the risk of myocardial infarction, stroke, coronary revascularization
and CV death. However, trials in patients with acute coronary syndromes (ACS) yielded
conflicting results, and two trials in patients with ischemic stroke did not show
a benefit. In patients with peripheral artery disease (PAD), preliminary observational
data suggested a potential benefit and a randomized trial is currently underway to
examine its efficacy in reducing CV and limb events.
The long-term safety data for low dose colchicine in ASCVD are reassuring. Although
pooled data from trials in ASCVD show a small (0.55%) absolute increase in the risk
of hospitalization for gastrointestinal events, adverse signals were not observed
for serious infection, cancer or severe myotoxicity.
In this article, we review the clinical studies of colchicine that examined its risk-benefit
for the prevention of CV events in patients with ASCVD, discuss clinical and research
implications, and highlight knowledge gaps.
