Does colchicine reduce adverse cardiovascular events in patients with coronary artery disease?
In patients with CAD, colchicine reduces the risk of myocardial infarction and ischemia-driven revascularization but increases gastrointestinal adverse events, without significantly affecting mortality.
Background: Inflammation is associated with an increased risk of adverse cardiovascular events in patients with coronary artery disease (CAD). Colchicine is an anti-inflammatory drug that can be used to improve clinical outcomes in patients with CAD. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane CENTRAL up to August 2025 to identify randomized controlled trials (RCTs) that reported clinical outcomes with the use of colchicine in CAD. Data for outcomes was extracted and summary estimates were generated using a random effects model. Results: 16 RCTs were included reporting data for 20,601 patients. The pooled analysis demonstrated a non-significant difference between colchicine and control groups for reducing all-cause death (RR: 0.97; 95 % CI, 0.78-1.22), cardiovascular death (RR: 0.98; 95 % CI, 0.79-1.21), and stroke (RR: 0.67; 95 % CI, 0.39-1.15). However, colchicine significantly reduced the risk of myocardial infarction (RR: 0.74; 95 % CI, 0.59-0.93), and ischemia-driven revascularization (RR = 0.72; 95 % CI, 0.53-0.99) at the expense of an increased risk of gastrointestinal adverse events (RR = 1.83; 95 % CI, 1.38-2.43) as compared to control. Conclusion: Colchicine does not reduce the relative risk of all-cause and cardiovascular death in patients with CAD. However, it can reduce the risk of myocardial infarction and ischemia drive revascularization. Additional trial data are required to confirm these findings.
Ahmed et al. (2025) studied this question.