Low-dose colchicine for atherosclerotic cardiovascular disease and the return of inflammation-targeted pharmacotherapy.

Abstract

Introduction: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of major cardiovascular events despite standard therapies. Residual inflammatory risk has emerged as an important therapeutic target, but translation into routine pharmacotherapy has been limited by cost, safety, route of administration, and uncertainty about patient selection. Low-dose colchicine, alkaloid with anti-inflammatory activity, has recently gained renewed interest as an oral adjunctive therapy for ASCVD risk reduction.

Areas covered: This review evaluates low-dose colchicine as inflammation-targeted pharmacotherapy for ASCVD. It discusses the clinical need, pivotal trial evidence, safety, drug-drug interactions, prescribing considerations, guideline positioning, real-world implementation, and unresolved questions. Colchicine Cardiovascular Outcomes Trial (COLCOT) after myocardial infarction, the Low-Dose Colchicine 2 (LoDoCo2) trial in chronic coronary disease, FDA approval of Lodoco 0.5 mg, and neutral evidence from Colchicine and Spironolactone in Patients with Myocardial Infarction/Organization for the Assessment of Strategies for Ischemic Syndromes 9 (CLEAR SYNERGY/OASIS-9) in acute myocardial infarction.

Expert opinion: This review contributes an integrated patient-selection framework that combines ischemic risk, chronic versus acute coronary setting, inflammatory phenotype, renal and hepatic safety, drug-interaction burden, tolerability, and patient preference. Its future clinical value will depend on careful patient selection, avoidance of interacting drugs, clarification of its role after acute myocardial infarction, and real-world evidence showing whether trial efficacy translates into routine cardiovascular prevention.