A better understanding of the central role of inflammation in the development of coronary artery disease (CAD) has been the impetus for the evaluation of therapeutic strategies targeting the interleukin-1ß/interleukin-6 cytokine signaling pathway, involved in both chronic atherogenesis and in triggering of atherosclerotic plaque rupture. As an inexpensive pharmacological agent which has relatively few adverse effects that tend to be mild and tolerable, the role of colchicine in secondary prevention of atherothrombotic events has been the focus of multiple recent large-scale randomized controlled trials involving patients with stable CAD (LoDoCo and LoDoCo2 trials), a recent myocardial infarction (COLCOT, COPS, and CLEAR SYNERGY trials), and undergoing percutaneous coronary interventions (PCI) (COLCHICINE-PCI trial). Based on this evidence, low-dose colchicine (0.5mg once daily) should be considered in patients with a recent myocardial infarction (within 30 days, and ideally within 3 days) or with stable CAD to improve cardiovascular outcomes. Colchicine should not be used in patients with severe renal or hepatic disease because of the risk of severe toxicity. No serious adverse effect was associated with the combined use of colchicine and high-intensity statin therapy in large trials. The impact of colchicine in high-risk populations of patients with peripheral arterial disease and in those with diabetes for the primary prevention of CAD remains to be established.
Copyright © 2021. Published by Elsevier Inc.