Colchicine in Cardiovascular Disease: Old Drug, New Use

Colchicine (Colcrys) is a promising adjunctive option in secondary prevention of cardiovascular events, probably because of its ability to stop or slow neutrophil reaction to intravascular cholesterol crystals.

Investigators recently looked at colchicine’s role in heart disease through a systematic review and meta-analysis of randomized, controlled trials. They searched for trials that randomized adult patients with cardiovascular disease to receive colchicine or either placebo or no therapy.

Colchicine was shown to reduce composite cardiovascular outcomes by 60%. The rates of pericarditis recurrence, post-operative atrial fibrillation, post-pericardiotomy syndrome, and post-cardiac surgery or radiofrequency ablation were nearly halved.

Benefits of colchicine were most apparent in stable coronary artery disease because it is driven by inflammation. Accordingly, benefits were limited in thromboembolism-driven acute coronary syndrome.

The leading adverse effect and reason for discontinuation was diarrhea and other gastrointestinal symptoms, which health care providers are already familiar with from colchicine’s use in gout and other inflammatory conditions.

Researchers have watched neutrophils with interest in patients with cardiovascular disease. Of note, colchicine inhibits neutrophil chemotaxis, ingress, and activation in inflammatory environments.

Controlling inflammation helps prevent pericarditis recurrence, but activated neutrophils are also present in atherosclerotic plaques. They seem to assist in the transformation of stable plaque to unstable plaque. By suppressing neutrophils, colchicine may help stabilize plaque and prevent fissuring or rupture that causes acute coronary ischemia or stroke.

This evidence supports the theory that colchicine’s anti-inflammatory properties have a place in cardiovascular disease therapy. The authors call for further randomized, controlled trials on colchicine use in this population and a dosage form that minimizes the drug’s adverse effects.