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Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation

  • Global Cardiovascular Health (L Sperling and D Gaita, Section Editors)
  • Published:
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Abstract

Purpose of Review

Targeting traditional cardiovascular risk factors is effective in reducing recurrent cardiovascular events, yet the presence of residual cardiovascular risk due to underlying systemic inflammation is a largely unaddressed opportunity. This review aims to comprehensively assess the evolving role of colchicine as a therapeutic approach targeting residual inflammatory risk in the context of those with coronary artery disease (CAD).

Recent Findings

Inflammation plays a significant role in promoting atherosclerosis, and targeting anti-inflammatory pathways has the potential to decrease cardiovascular events. Low-dose colchicine (0.5 mg/day orally), when added to guideline-directed medical care for CAD, safely decreases major adverse cardiovascular events (MACE) by 31% in stable atherosclerosis patients and 23% in those after recent myocardial infarctions. Meta-analyses of recent randomized control trials further support both the efficacy and safety of colchicine, particularly when added to other standard cardiovascular therapies, including statin therapy. The European Society of Cardiology and other national guidelines endorse the use of low-dose colchicine in patients across the spectrum of CAD. Recently, colchicine was FDA-approved in the United States as the first anti-inflammatory therapy for the reduction of cardiovascular events. In a period of a rising incidence of CAD across the globe, colchicine represents a unique opportunity to decrease MACE due to its large magnitude of benefits and general affordability. However, challenges with drug interactions must be addressed, especially in those regions where HIV, hepatitis, and tuberculosis are prevalent.

Summary

Colchicine is safe and effective at reducing cardiovascular events across a broad spectrum of coronary syndromes. The ability to simultaneously target traditional risk factors and mitigate residual inflammatory risk marks a substantial advancement in cardiovascular prevention strategies, heralding a new era in the global battle against CAD.

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Funding

The authors did not receive support from any organization for the submitted work. Brittany Weber reports support from NIH K23 and AHA Career Developmental Award, outside the submitted work.

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Authors and Affiliations

  1. Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA

    Robert S. Zhang & Michael S. Garshick

  2. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Brittany N Weber

  3. Coronary Care Unit, National Institute of Cardiology of Mexico, Mexico, Mexico

    Diego Araiza-Garaygordobil

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R.S.Z wrote the main manuscript text and prepared the figures. All authors reviewed the manuscript and made meaningful contributions.

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Correspondence to Michael S. Garshick.

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Conflict of Interest

Brittany Weber reports being on the Scientific Advisory Boards for Kiniksa, NovoNordisk, BMS, Horizon, and Agepha; honoraria from AWIR and ACR 2023 and ACR 2024; and Esperion Women Leadership Board. Michael S. Garshick reports consultant fees from Agepha, Kiniksa, BMS, and Horizon Pharmaceuticals (part of Amgen). The other authors declare that they have no conflict of interest.

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Zhang, R.S., Weber, B.N., Araiza-Garaygordobil, D. et al. Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02049-y

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