# Does low-dose colchicine reduce cardiovascular events in coronary disease?

Canonical page: https://cliniatlas.com/evidence/colchicine-secondary-prevention-coronary-disease/

**Summary:** Yes — roughly a quarter to a third fewer ischaemic events in two randomised trials, on top of standard therapy.

COLCOT randomised 4,745 patients within 30 days of myocardial infarction to colchicine 0.5 mg daily or placebo. The primary composite of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalisation for angina leading to revascularisation occurred in 5.5% on colchicine versus 7.1% on placebo [1].

LoDoCo2 extended the finding to stable disease, randomising 5,522 patients with chronic coronary disease to colchicine 0.5 mg daily or placebo and reporting a significantly lower incidence of cardiovascular events over a median of roughly 29 months [2]. Together the trials support an anti-inflammatory contribution to residual cardiovascular risk.

Neither trial demonstrated a reduction in all-cause mortality, and LoDoCo2 recorded a numerically higher rate of non-cardiovascular death whose significance remains debated [2]. Gastrointestinal intolerance is the main practical limitation, and colchicine requires caution with renal impairment and interacting drugs.

## Limitations

- Benefit is on composite ischaemic endpoints; neither trial showed reduced all-cause mortality, and a non-cardiovascular death signal in LoDoCo2 is unresolved.
- Patients with significant renal or hepatic impairment were excluded, and colchicine has clinically important interactions including with strong CYP3A4 inhibitors.

## Sources

1. [IV / Randomised trial] Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. New England Journal of Medicine (2019). PMID 31733140. https://pubmed.ncbi.nlm.nih.gov/31733140/
2. [IV / Randomised trial] Colchicine in Patients with Chronic Coronary Disease. New England Journal of Medicine (2020). PMID 32865380. https://pubmed.ncbi.nlm.nih.gov/32865380/

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