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

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.