Values & turf
A values / turf tradeoff — more data alone will not resolve it.
Resolves via: Shared decision-making + role clarity
If the benefit is real, many statin-treated coronary patients are missing a cheap, approved pill that prevents heart attacks and strokes. If it isn't, we are handing them diarrhea and drug interactions for nothing.
Active since Oct 2024
The debate
9 clinicians quoted on the record
Two large positive trials, FDA approval, and the inflammation hypothesis all point the same way, so one neutral trial in a different setting shouldn't erase a proven way to lower risk that statins leave behind.
“We routinely use colchicine at the 0.5 mg, FDA-approved dose, for a long-term reduction in cardiovascular risk.”
How this gets settled
Who could settle it
Who could fund or run it
Sources & verification
“The odd player out is [CLEAR SYNERGY], not the other trials.”
+ 1 more on this side
The newest and cleanest large trial in heart attack patients showed no benefit, so a poorly tolerated drug with a large number-needed-to-treat no longer earns a place in everyday prevention.
“My father had an MI and I put him on colchicine. I've just taken him off.”
“I never wanted to start a patient on it and now I have good rationale for not doing so.”
Where the experts land
3–2 on record · 4 unplaced
Use it for residual risk · 3
On the record, unplaced · 4
Drop routine use · 2
“The odd player out is [CLEAR SYNERGY], not the other trials.”
Who we found publicly on the record — a snapshot, not a poll of the field. Larger dots are deciders; dashed dots are scan-reported, not yet verified.
Where the field stands
Common ground
Inflammation drives coronary events, and colchicine is not a drug for every patient.
The crux
Does the neutral CLEAR SYNERGY result override the earlier positive trials, or is it the outlier?
Still unknown
A trial targeting high-risk or high-inflammation patients that clearly confirms or refutes benefit would settle it.
On the record
Their own words — position stated as published
“RCTs for colchicine are mixed”
Gregg Fonarow · Cardiologist · X ↗
keep colchicine; CLEAR is the outlier
“You have two classes of drugs that show benefits on atherosclerotic events with a pure anti-inflammatory therapy, such as canakinumab and colchicine, and you have one trial that's kind of the odd man out, and I don't buy it.”
Steven Nissen · Cleveland Clinic · Medscape ↗
CLEAR SYNERGY is more than uncertain
“I think you are selling yourself short.”
J. Dawn Abbott · Interventional cardiologist · Medscape ↗
skeptical of pooled benefit
“It is not clear to me what these pooled analyses offer that we didn’t know from the individual trials.”
Sanjay Kaul · Cedars-Sinai · TCTMD ↗
Where do you land?
No votes yet — the measured split appears at 10.
Where the evidence stands
COLCOT and LoDoCo2 reduced MACE ~23–31% and underpinned FDA approval plus ESC Class IIa in chronic CAD. CLEAR SYNERGY (n>7000, post-MI PCI) was neutral (HR 0.99) despite CRP lowering. 2025 ACC/AHA ACS guidelines give only Class 2b after ACS. Two 2025 meta-analyses still show 12–25% MACE reductions depending on which trials are pooled. Unknown: whether the miss is ACS-timing, COVID-era noise, or true lack of effect on contemporary background therapy.
What's settled
4What's still open
4Know an expert who could settle this? Suggest one →
Institutions that could fund, run, or adopt
+ 37 more, each dated and verification-tagged