Key result
Low-dose colchicine cuts ischemic stroke ~26% vs. placebo in secondary prevention.
Why the study?
Although colchicine is a potential anti-inflammatory strategy to address residual inflammatory risk in secondary cardiovascular prevention, its optimal dosing regimen and target patient populations remain unclear.
Does low-dose versus higher-dose colchicine reduce the risk of ischemic stroke and cardiovascular events in patients with a history of ischemic stroke or cardiovascular disease?
Meta-Analysis (n=24,967)
Does low-dose versus higher-dose colchicine reduce the risk of ischemic stroke and cardiovascular events in patients with a history of ischemic stroke or cardiovascular disease?
Low-dose colchicine (0.5 mg/day) is effective and superior to higher doses for reducing ischemic stroke, myocardial infarction, and adverse cardiovascular events in secondary cardiovascular prevention.
Answers are grounded in this paper and cite their sources.
Low-dose colchicine merits consideration in secondary prevention; confirms stroke reduction and extends evidence favoring 0.5 mg daily dosing.
Residual inflammatory risk remains an important contributor to recurrent cardiovascular events despite advances in standard secondary prevention therapies. Colchicine has emerged as a potential anti-inflammatory strategy for reducing cardiovascular risk; however, the optimal dosing regimen and target patient populations remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of low-dose versus higher-dose colchicine for the secondary prevention of ischemic stroke and cardiovascular outcomes. Databases were systematically searched from inception to February 20, 2025, for randomized controlled trials comparing colchicine with placebo in patients with a history of ischemic stroke, cardiovascular disease, or cardiovascular events. The primary outcome was ischemic stroke incidence; secondary outcomes included adverse cardiovascular events (ACE), myocardial infarction (MI), and mortality. Subgroup analyses were performed according to dose (â¤0.5 mg/day vs >0.5 mg/day), age, sex predominance, and trial sample size. Sixteen randomized controlled trials involving 24,967 participants were included. Overall, low-dose colchicine significantly reduced the risk of ischemic stroke (RR 0.74, 95% CI 0.59â"0.92, p ≤ 0.007), particularly among patients younger than 65 years (RR 0.36, 95% CI 0.17â"0.78, p ≤ 0.009). Colchicine significantly reduced ACE (RR 0.72, 95% CI 0.65â"0.80) and MI (RR 0.79, 95% CI 0.66â"0.95, p ≤ 0.010), with greater benefits observed with low-dose and once-daily regimens. Low-dose colchicine (0.5 mg/day) appears more effective than higher doses for the secondary prevention of ischemic stroke and cardiovascular events. These findings support consideration of low-dose colchicine as adjunctive therapy in selected patients requiring secondary cardiovascular prevention.
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Alsheikh et al. (2026) conducted a meta-analysis in History of ischemic stroke, cardiovascular disease, or cardiovascular events (n=24,967). Colchicine vs. Placebo was evaluated on Ischemic stroke incidence (RR 0.74, 95% CI 0.59-0.92, p=≤0.007). Low-dose colchicine (≤0.5 mg/day) significantly reduced ischemic stroke risk compared with placebo (RR 0.74, 95% CI 0.59-0.92, p≤0.007) in secondary cardiovascular prevention.
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