Efficacy and Safety of Colchicine for Secondary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Abstract

Colchicine may reduce cardiovascular events in coronary artery disease (CAD) through its anti-inflammatory effects. PubMed, Scopus, and Cochrane Library were searched from inception to May 10, 2025, for randomized controlled trials (RCTs) comparing colchicine with placebo or usual care in patients with CAD. Eligible trials had ≥ 30 days of colchicine use and reported cardiovascular outcomes. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included extended MACE (eMACE), myocardial infarction (MI), stroke, all-cause mortality, cardiovascular mortality, coronary revascularization, gastrointestinal events, infection, myalgia, arrhythmia, cancer, alopecia, and treatment discontinuation. Random-effects models were used to calculate risk ratios with 95% CIs. Heterogeneity was assessed using the I² statistic, and meta-regression analysis was conducted to explore heterogeneity and potential effect modifiers. Eleven studies included 19,618 patients with 9814 and 9804 patients in the colchicine and control groups, respectively. The colchicine group was significantly associated with a lower rate of MACE compared to the control group (RR = 0.73, 95% CI = 0.59-0.92, p = 0.006; I² = 44%). From the secondary outcomes, eMACE (RR = 0.66, 95% CI = 0.52-0.85; p = 0.001; I² = 73%), MI (RR = 0.82, 95% CI = 0.70-0.96, p = 0.01), and coronary revascularization (RR = 0.60, 95% CI = 0.41-0.87, p = 0.007) were found to be significantly lower in the colchicine group. All the other secondary outcomes did not reach statistical significance. Meta-regression analysis for MACE showed a statistically significant association with diabetes (coefficient: -0.0778, p = 0.0013), indicating a potential modifying effect. Other covariates, including mean age, hypertension, smoking, and prior revascularization, did not demonstrate statistically significant associations. Colchicine reduces MACE, MI, and revascularization in CAD patients, supporting its use for secondary prevention.