Colchicine in Cardiovascular Disease: Evidence Structure, Clinical Efficacy, Safety, and Translational Positioning Across Cardiovascular Syndromes

Scheme 1. Colchicine structure [4].

Figure 1. Conceptual map of populations and study architectures in the colchicine cardiovascular literature. The figure summarizes the principal clinical populations represented in this section—centered on ACS, MI, CAD, atrial fibrillation, recurrent pericarditis, heart failure, and PAD—and contrasts the most methodologically robust evidence structures, such as multicenter randomized trials, matched retrospective cohorts, evidence syntheses, and nested sub-studies, with more fragmented settings represented by inflammatory populations, pediatric cohorts, animal models, ex vivo tissue studies, and in vitro experiments.

Figure 2. Overview of the intervention and outcome framework of colchicine studies. The figure summarizes the recurring study designs in the literature, linking colchicine dose and timing, comparator structure, and major outcome domains, including cardiovascular events, procedural and arrhythmic complications, imaging progression, biomarkers, mechanistic readouts, patient-reported outcomes, and economic endpoints.

Figure 3. Integrated schematic summary of the findings associated with colchicine across cardiovascular settings. Central anti-inflammatory and plaque-modifying effects include attenuation of hs-CRP, inflammasome-related activity, macrophage and neutrophil extracellular trap pathways, and plaque remodeling. These biologic effects align with the most consistent clinical findings—reduction in non-fatal ischemic events, postoperative AF, recurrent pericarditis, and lower-limb ischemic complications—while benefit remains less consistent in ACS, recent MI, and STEMI, and gastrointestinal intolerance and treatment discontinuation remain the principal harms.

Figure 4. Visual summary of the Interpretation and Evidence Value of colchicine across cardiovascular settings. The figure highlights the central interpretive pattern of the evidence: the strongest and most consistent clinical value is seen in chronic CAD and established atherosclerosis, with additional favorable signals in recurrent pericarditis and postoperative AF, whereas evidence is weaker or more inconsistent in ACS, recent MI, and PCI-related settings. It also emphasizes the key safety constraint of gastrointestinal intolerance and the unresolved nature of long-term net safety, while underscoring that the overall benefit is driven primarily by reduction in non-fatal outcomes rather than proven mortality improvement.