Key messages
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People with cardiovascular disease (i.e. affecting the heart and blood vessels) who use low-dose colchicine for at least six months will reduce their risk of myocardial infarction (heart attack) and stroke, without increasing their risk of serious side effects.
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Taking low-dose colchicine probably does not reduce the risk of death from any cause or specifically from heart disease, or affect the number of people who need treatment to widen blood vessels in their heart.
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Taking colchicine use seems to increase the risk of gastrointestinal adverse events (e.g. diarrhoea, nausea), but these are usually mild and pass quickly.
Background
Cardiovascular disease (i.e. diseases affecting your heart and blood vessels) is often caused by low-level inflammation throughout the body, leading to repeated major adverse (negative) cardiovascular events (e.g. heart attack, stroke, or death). Colchicine is an established anti-inflammatory medication that is cheap, widely available, and taken by mouth, making it a promising extra treatment for people at high risk of cardiovascular events happening again.
What did we want to find out?
In recent years, a number of studies known as 'randomised controlled trials' have been conducted to examine the benefits and harms of low-dose colchicine treatment to prevent further cardiovascular events, such as heart attack or stroke, after a first incident ('secondary prevention'). The aim of this review was to provide a systematic assessment of the benefits and harms of using colchicine for at least six months in adults with established cardiovascular disease or who have had a recent cardiovascular event.
What did we do?
We searched for all the studies examining the effects of low-dose colchicine in people with cardiovascular disease for at least six months, compared to a placebo (fake) intervention or no treatment. We systematically extracted information from all the relevant studies and assessed how well they were carried out. We then combined their findings and judged the reliability of the evidence.
Our main outcomes were: death from any cause (all-cause mortality), heart attack (myocardial infarction), stroke, treatment to widen heart vessels (coronary revascularisation), death from a cardiovascular cause (cardiovascular mortality), quality of life, serious adverse events (negative side effects), and digestive system (gastrointestinal) adverse events.
What did we find?
We identified 12 studies that involved 22,983 patients with cardiovascular disease and investigated the benefits and harms of low-dose colchicine treatment.
High-certainty evidence shows that a treatment with low-dose colchicine reduces the risk of myocardial infarction and stroke, without increasing the risk of serious adverse events. However, colchicine is associated with a higher risk of gastrointestinal side effects, though these were mild and passed quickly. The evidence suggests that colchicine probably does not reduce the risk of dying or of needing coronary revascularisation. The effects on quality of life and hospitalisations are unknown because the available studies did not measure these outcomes.
What are the limitations of the evidence?
We have high confidence in the finding that low-dose colchicine reduces the risk of heart attack and stroke. Our level of confidence in the other findings is moderate, so it is possible that future studies may change these findings. Further research is needed to investigate the long-term effects on mortality and quality-of-life. This will require studies that last longer and involve more people.
How up-to-date is this evidence?
This review is based on searches of the medical literature that were carried out up to 18 February 2025.
Baca abstrak penuh
Matlamat
To evaluate the benefits and harms of low‐dose colchicine in the prevention of cardiovascular events in adults with a history of stable CVD or following myocardial infarction or stroke.
Kaedah Pencarian
We conducted a comprehensive search of the literature until February 2025 using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the drugs@FDA database, references of key papers, and references of included studies.
Kesimpulan Pengarang
People with cardiovascular disease using low-dose colchicine as secondary prevention for at least six months benefit from reduced rates of myocardial infarction and stroke, without an increase in serious adverse events. Moderate-certainty evidence did not show a benefit from low-dose colchicine for the risk of mortality (i.e. all-cause and cardiovascular mortality) or coronary revascularisation rates. Colchicine use was associated with an increased risk of gastrointestinal adverse events, which were typically described as mild and transient in nature. Additional studies are warranted to investigate the benefits and harms of low-dose colchicine in relevant subgroups and in specific indications, such as long-term use in individuals with stable coronary artery disease versus limited-time use following acute coronary syndrome.
Funding
Review author FE was supported by the Margot und Erich Goldschmidt & Peter René Jacobson Foundation. Review author CMS was supported by the Janggen Pöhn Foundation and the Swiss National Science Foundation (MD-PhD grant Number: 323530_221860).
Registration
This review is based on its protocol, which is available via DOI 10.1002/14651858.CD014808, and a previous review, which is available via DOI 10.1002/14651858.CD011047.pub2.
