A widely-used, inexpensive gout drug could reduce heart attacks and strokes in people with cardiovascular disease, according to a new Cochrane review.

The review examined the effects of low doses of colchicine, a drug used to treat gout, and found no increase in serious side effects.

Cardiovascular disease is often driven by chronic low-grade inflammation, which contributes to recurrent cardiovascular events such as heart attacks and strokes. Colchicine has anti-inflammatory properties that make it a promising option for people with heart disease. 

A promising effect on cardiovascular risk

The review included 12 randomized controlled trials involving nearly 23,000 people with a history of heart disease, heart attack or stroke. The studies looked at patients who took colchicine for at least six months, with doses of 0.5 mg once or twice a day. Most participants were male (~80%) and the mean age was 57 to 74 years old. Half received colchicine, while the other half received either a placebo or no additional treatment alongside their usual care.

Overall, those taking low-dose colchicine were less likely to experience a heart attack or stroke. For every 1,000 people treated, there were 9 fewer heart attacks and 8 fewer strokes compared with those not taking the drug. Whilst there were no serious adverse events identified, patients who took colchicine were more likely to have stomach or digestive side effects, but these were usually mild and didn’t last long.

Among 200 people with cardiovascular disease – where we would normally expect around seven heart attacks and four strokes – using low-dose colchicine could prevent about two of each. Reductions like this can make a real difference for patients who live with ongoing, lifelong cardiovascular risk.

- Dr Ramin Ebrahimi, co-lead author from the University Medicine Greifswald, Germany

A new use for a long-established medicine

As cardiovascular diseases are the leading cause of death globally, colchicine presents a promising inexpensive and accessible option for secondary prevention in high-risk patients.

These results come from publicly funded trials repurposing a very old, low-cost drug for an entirely new use. It shows the power of academic research to reveal treatment opportunities that traditional drug development often overlooks.

 - Lars Hemkens, senior author from the University of Bern, Switzerland

The evidence is less clear when it comes to whether colchicine affects overall death rates or the need for procedures like coronary revascularization. The studies didn’t provide any information to say whether the drug improves quality of life or reduces hospital stays. The authors stress that further research is needed in these areas.