Colchicine for Secondary Prevention of Atherothrombotic Events After Myocardial Infarction

Abstract

Introduction: Inflammation drives residual cardiovascular risk after myocardial infarction (MI) despite optimal antiplatelet and statin therapy. Colchicine, a low-cost anti-inflammatory drug, may reduce recurrent events, but concerns about gastrointestinal tolerability exist.
Methods: A systematic review and meta-analysis of randomized controlled trials comparing colchicine (0.5 mg daily) to placebo added to standard care in patients with recent MI. Outcomes: MACE (cardiovascular death, MI, stroke, urgent revascularization) and adverse events. Searched clinicaltrials.gov, Cochrane, and Medline (2015–2024).
Results: 4 RCTs (n=7,645) were included: COLCOT, LoDoCo2, COPS, and CLEAR-Sync. Median follow-up 22 months. Colchicine reduced MACE by 31% (HR 0.69, 95%CI 0.57–0.83; p<0.001). Number needed to treat for 2 years = 38. All-cause mortality was not significantly reduced (HR 0.86, 0.71–1.04). Gastrointestinal adverse events (diarrhea, nausea) occurred more often with colchicine (12% vs. 8%, RR 1.5), leading to discontinuation in 4% (vs. 1.5% placebo). No excess infection or myotoxicity.
Discussion: The consistent benefit across trials supports a key inflammatory pathway in atherothrombosis. Limitations include open-label design in LoDoCo2 and exclusion of severe CKD (eGFR <30). Long-term safety beyond 3 years is unknown.
Conclusions: Colchicine 0.5 mg daily reduces recurrent MACE in post-MI patients with acceptable safety profile, though gastrointestinal side effects are common. It should be considered as adjunctive therapy, particularly in patients with residual inflammatory risk.