Colchicine in modern cardiology: opportunities, limitations and promising results. An analytical review of the recent clinical trial outcomes

Background. Colchicine, traditionally used for gout treatment, has recently emerged as a promising therapeutic option for coronary artery disease (CAD) due to its anti-inflammatory properties. However, its use is accompanied by conflicting clinical data and potential risks.
Objective. To systematize current evidence on the efficacy and safety of colchicine in cardiovascular diseases, identifying key areas of certainty and uncertainty.
Design and methods. We analyzed 35 clinical studies (2021-2025), including randomized controlled trials (LoDoCo2, COLCOT, CLEAR), meta-analyses and cohort studies. The study was supported by the Russian Science Foundation (Agreement No. 25-15-20110).
Results. Proven benefits: 28 % reduction in cardiovascular events in chronic CAD; atherosclerotic plaque stabilization (+ 34,2 μm fibrous cap thickness); 33 % reduction in postoperative atrial fibrillation. Controversial data: no benefit in acute coronary syndrome (odds ratio (OR) 0,99); increased dementia risk with long-term use (OR 1,45). Safety concerns: gastrointestinal complications (+ 3,6 %); trend toward increased non-cardiac mortality (+ 38 %); dose-dependent increase in dementia risk (+ 45 %).
Conclusion. Colchicine represents a promising tool for secondary prevention of atherothrombosis, combining centuries of clinical experience with modern understanding of inflammatory mechanisms. Its niche included patients with chronic CAD and persistent inflammatory activity, where it complements standard therapy without increasing bleeding risk, unlike more aggressive antithrombotic strategies. Further research should clarify its role in acute settings and optimize dosing regimens considering individual safety profiles.

1. Chong B, Jayabaskaran J, Jauhari SM, Chan SP, Goh R, Kueh MTW, et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol. 2025;32(11):1001–1015. https://doi.org/10.1093/eurjpc/zwae281

2. von Ehr A, Steenbuck ID, Häfele C, Remmersmann F, Vico TA, Ehlert C, et al. Experimental evidence on colchicine's mode of action in human carotid artery plaques. Atherosclerosis. 2025;406:119239. https://doi.org/10.1016/j.atherosclerosis.2025.119239

3. Tercan H, van Broekhoven A, Bahrar H, Opstal T, Cossins BC, Rother N, et al. The effect of low-dose colchicine on the phenotype and function of neutrophils and monocytes in patients with chronic coronary artery disease: a double-blind randomized placebo-controlled cross-over study. Clin Pharmacol Ther. 2024;116(5):1325–1333. https://doi.org/10.1002/cpt.3394

4. Yu M, Yang Y, Dong SL, Zhao C, Yang F, Yuan YF, et al. Effect of colchicine on coronary plaque stability in acute coronary syndrome as assessed by optical coherence tomography: the COLOCT randomized clinical trial. Circulation. 2024;150(13):981–993. https://doi.org/10.1161/CIRCULATIONAHA.124.069808

5. Samuel M, Tardif JC, Bouabdallaoui N, Khairy P, Dubé MP, Blondeau L, et al. Colchicine for secondary prevention of cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Can J Cardiol. 2021;37:776–785. https://doi.org/10.1016/j.cjca.2020.10.006

6. Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415–3537. https://doi.org/10.1093/eurheartj/ehae177

7. Nidorf SM, Ben-Chetrit E, Ridker PM. Low-dose colchicine for atherosclerosis: long-term safety. Eur Heart J. 2024;45(18):1596–1601. https://doi.org/10.1093/eurheartj/ehae208

8. Mohammadnia N, Wesselink BE, Bax WA, Nidorf SM, Mosterd A, Fiolet ATL, et al. Cardiovascular benefit of colchicine in relation to baseline risk: a secondary analysis of the LoDoCo2 Trial. J Am Heart Assoc. 2025;14(10): e038687. https://doi.org/10.1161/JAHA.124.038687

9. Roubille F, Bouabdallaoui N, Kouz S, Waters DD, Diaz R, Maggioni AP, et al. Low-dose colchicine in patients with type 2 diabetes and recent myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Diabetes Care. 2024;47(3):467–470. https://doi.org/10.2337/dc23-1825

10. Jolly SS, d'Entremont MA, Lee SF, Mian R, Tyrwhitt J, Kedev S, et al. Colchicine in acute myocardial infarction. N Engl J Med. 2025;392(7):633–642. https://doi.org/10.1056/NEJMoa2405922

11. Chen PY, Tseng CC, Lee YT, Yip HT, Chang R, Wei JC. Association between colchicine use and the risk of dementia among patients with gout: a nationwide retrospective cohort study. Int J Rheum Dis. 2024;27(5): e15162. https://doi.org/10.1111/1756-185X.15162

12. Tucker B, Goonetilleke N, Patel S, Keech A. Colchicine in atherosclerotic cardiovascular disease. Heart. 2024;110(9):618–625. https://doi.org/10.1136/heartjnl-2023-323177

13. Pan Y, Fan F, Jiang J, Zhang Y. Clinical outcomes of anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in coronary artery disease patients: a systemic review and meta-analysis of 37,056 individuals from 32 randomized trials. Inflamm Res. 2025;74(1):99. https://doi.org/10.1007/s00011-025-02058-9

14. Martínez GJ, Celermajer DS, Patel S. The NLRP3 inflammasome and the emerging role of colchicine to inhibit atherosclerosis-associated inflammation. Atherosclerosis. 2018;269:262–271. https://doi.org/10.1016/j.atherosclerosis.2017.12.027

15. Li Y, Zhang Y, Lu J, Yin Y, Xie J, Xu B. Anti-inflammatory mechanisms and research progress of colchicine in atherosclerotic therapy. J Cell Mol Med. 2021;25(17):8087–8094. https://doi.org/10.1111/jcmm.16798

16. Li X, Luo Y, Cai X, Lv Z, Kong Y, Guo Q, Zhu J, Pan T, Wang D. Anti-inflammatory effect of colchicine on organ damage during the perioperative period of cardiac surgery: a study protocol for a multicentre, randomised, double-blind, placebo-controlled clinical trial. BMJ Open. 2024;14(9): e084368. https://doi.org/10.1136/bmjopen-2024-084368

17. Budgeon CA, Nidorf S, Mosterd A, Fiolet A, Eikelboom J, O'Halloran S, et al. Exploration of the regional effects of colchicine in the LoDoCo2 trial. Am Heart J. 2024;278:186–194. https://doi.org/10.1016/j.ahj.2024.09.006

18. Fiolet ATL, Keusters W, Blokzijl J, Nidorf SM, Eikelboom JW, Budgeon CA, et al. Cost-effectiveness of low-dose colchicine in patients with chronic coronary disease in The Netherlands. Eur Heart J Qual Care Clin Outcomes. 2025;11(1):89–96. https://doi.org/10.1093/ehjqcco/qcae021

19. Samuel M, Berry C, Dubé MP, Koenig W, López-Sendón J, Maggioni AP, et al. Long-term trials of colchicine for secondary prevention of vascular events: a meta-analysis. Eur Heart J. 2025;46(26):2552–2563. https://doi.org/10.1093/eurheartj/ehaf174

20. Psaltis PJ, Nguyen MT, Singh K, Sinhal A, Wong DTL, Alcock R, et al. Optical coherence tomography assessment of the impact of colchicine on non-culprit coronary plaque composition after myocardial infarction. Cardiovasc Res. 2025;121(3):468–478. https://doi.org/10.1093/cvr/cvae191

21. Opstal TSJ, Fiolet ATL, van Broekhoven A, Mosterd A, Eikelboom JW, Nidorf SM, et al. Colchicine in patients with chronic coronary disease in relation to prior acute coronary syndrome. J Am Coll Cardiol. 2021;78(9):859–866. https://doi.org/10.1016/j.jacc.2021.06.037

22. Fiolet ATL, Opstal TSJ, Mosterd A, Eikelboom JW, Jolly SS, Keech AC, et al. Efficacy and safety of low-dose colchicine in patients with coronary disease: a systematic review and meta-analysis of randomized trials. Eur Heart J. 2021;42(28):2765–2775. https://doi.org/10.1093/eurheartj/ehab115

23. Dawson LP, Quinn S, Tong D, Boyle A, Hamilton-Craig C, Adams H, et al. Colchicine and quality of life in patients with acute coronary syndromes: results from the COPS randomized trial. Cardiovasc Revasc Med. 2022;44:53–59. https://doi.org/10.1016/j.carrev.2022.06.017

24. Hassanain HA, El Wakeel LM, Khorshid H. Colchicine effect on biomarkers of cardiac remodelling and atherosclerosis in ST-elevation myocardial infarction: a randomized controlled trial. Br J Clin Pharmacol. 2025;91(2):427–438. https://doi.org/10.1111/bcp.16270

25. Vaidya K, Tucker B, Kurup R, Khandkar C, Pandzic E, Barraclough J, et al. Colchicine inhibits neutrophil extracellular trap formation in patients with acute coronary syndrome after percutaneous coronary intervention. J Am Heart Assoc. 2021;10(1): e018993. https://doi.org/10.1161/JAHA.120.018993

26. Li J, Meng X, Shi FD, Jing J, Gu HQ, Jin A, et al. Colchicine in patients with acute ischaemic stroke or transient ischaemic attack (CHANCE-3): multicentre, double blind, randomised, placebo controlled trial. BMJ. 2024;385: e079061. https://doi.org/10.1136/bmj-2023-079061

27. Zhu S, Pan W, Yao Y. The efficacy of colchicine compared to placebo for preventing ischemic stroke among individuals with established atherosclerotic cardiovascular diseases: a systematic review and meta-analysis. Scand Cardiovasc J. 2025;59(1):2441112. https://doi.org/10.1080/14017431.2024.2441112

28. Andreis A, Imazio M, Piroli F, Avondo S, Casula M, Paneva E, De Ferrari GM. Efficacy and safety of colchicine for the prevention of major cardiovascular and cerebrovascular events in patients with coronary artery disease: a systematic review and meta-analysis on 12 869 patients. Eur J Prev Cardiol. 2022;28(17):1916–1925. https://doi.org/10.1093/eurjpc/zwab045

29. Escalera E, Saver JL. Magnitude of effect of low dose colchicine, a newly food and drug administration approved treatment for stroke prevention. J Stroke Cerebrovasc Dis. 2025;34(2):108186. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108186

30. Vergallo R, Galiuto L. Targeting inflammation with colchicine does not prevent atrial fibrillation after major non-cardiac thoracic surgery. Eur Heart J. 2024;45(12):985–986. https://doi.org/10.1093/eurheartj/ehae006

31. Tabbalat RA, Alhaddad I, Hammoudeh A, Khader YS, Khalaf HA, Obaidat M, et al. Effect of low-dose colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF low dose trial. J Int Med Res. 2020;48(7):300060520939832. https://doi.org/10.1177/0300060520939832

32. Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, et al. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011;124(21):2290–2295. https://doi.org/10.1161/CIRCULATIONAHA.111.026153

33. Rivera FB, Whoy Cha S, Aparece JP, Jariyatamkitti S, Mamas MA. Efficacy and safety of colchicine for the prevention of postoperative atrial fibrillation among patients undergoing major cardiothoracic surgery: a meta-analysis and meta-regression of randomized controlled trials. J Cardiovasc Pharmacol. 2024;83(3):265–270. https://doi.org/10.1097/FJC.0000000000001533

34. Romero JE, Matos CD, Garcia F, Enriquez A, Saenz LC, Hoyos C, Alviz I, et al. Intrapericardial corticosteroids and colchicine prevent pericarditis and atrial fibrillation after epicardial ablation of ventricular arrhythmias. JACC Clin Electrophysiol. 2025;11(3):498–508. https://doi.org/10.1016/j.jacep.2024.10.033

35. Al-Sadawi M, Aslam F, Henriques MD, Alsaiqali M, Gier C, Kim P, et al. Effect of low dose colchicine on long term recurrence after atrial fibrillation ablation. Int J Cardiol. 2025;423:132972. https://doi.org/10.1016/j.ijcard.2025.132972

36. Conen D, Ke Wang M, Popova E, Chan MTV, Landoni G, Cata JP, et al. Effect of colchicine on perioperative atrial fibrillation and myocardial injury after non-cardiac surgery in patients undergoing major thoracic surgery (COP-AF): an international randomised trial. Lancet. 2023;402(10413):1627–1635. https://doi.org/10.1016/S0140-6736(23)01689-6

37. Pascual-Figal D, Núñez J, Pérez-Martínez MT, González-Juanatey JR, Taibo-Urquia M, Llàcer-Iborra P, et al. Colchicine in acutely decompensated heart failure: the COLICA trial. Eur Heart J. 2024;45(45):4826–4836. https://doi.org/10.1093/eurheartj/ehae538

38. Pascual-Figal D, Núñez Villota J, Pérez-Martínez MT, González-Juanatey JR, Taibo-Urquía M, Llàcer Iborra P, et al. Colchicine in acute heart failure: rationale and design of a randomized double-blind placebo-controlled trial (COLICA). Eur J Heart Fail. 2024;26(9):1999–2007. https://doi.org/10.1002/ejhf.3300

39. Tramujas L, Nogueira A, Felix N, de Barros E Silva PGM, Abizaid A, Cavalcanti AB. Association of colchicine use with cardiovascular and limb events in peripheral artery disease: insights from a retrospective cohort study. Atherosclerosis. 2024;398:118563. https://doi.org/10.1016/j.atherosclerosis.2024.118563

40. Cipolletta E, Nakafero G, McCormick N, Yokose C, Avery AJ, et al. Cardiovascular events in patients with gout initiating urate-lowering therapy with or without colchicine for flare prophylaxis: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data. Lancet Rheumatol. 2025;7(3): e197–e207. https://doi.org/10.1016/S2665-9913(24)00248-0

41. Maisch B, Seferović PM, Ristić AD, Erbel R, RienmüllerR, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; the Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004;25(7):587–610. https://doi.org/10.1016/j.ehj.2004.02.002

42. Lutschinger LL, Rigopoulos AG, Schlattmann P, Matiakis M, Sedding D, Schulze PC, et al. Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome. BMC Cardiovasc Disord. 2019;19(1):207. https://doi.org/10.1186/s12872-019-1190-4

43. Avondo S, Andreis A, Casula M, Biondi-Zoccai G, Imazio M. Pharmacologic treatment of acute and recurrent pericarditis: a systematic review and meta-analysis of controlled clinical trials. Panminerva Med. 2021;63(3):314–323. https://doi.org/10.23736/S0031-0808.21.04263-4

44. Myachikova VYu, Titov VA, Maslyanskiy AL, Moiseeva OM. Idiopathic recurrent pericarditis — a paradigm shift? Russian Journal of Cardiology. 2019;(11):155–163. (In Russ.) https://doi.org/10.15829/1560-4071-2019-11-155-163

45. Desai D, Maheta D, Agrawal SP, Shah AB, Panchal A, Shah H, et al. Comparative efficacy and safety of colchicine and interleukin-1 antagonists in recurrent pericarditis: a network meta-analysis. Panminerva Med. 2025;67(1):37–45. https://doi.org/10.23736/S0031-0808.24.05269-8

46. Stewart S, Yang KCK, Atkins K, Dalbeth N, Robinson PC. Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2020;22(1):28. https://doi.org/10.1186/s13075-020-2120-7

47. Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in patients with chronic coronary disease. N Engl J Med. 2020;383(19):1838–1847. https://doi.org/10.1056/NEJMoa2021372

48. Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019;381(26):2497–2505. https:// doi.org/10.1056/NEJMoa1912388

49. Ehsan M, Syed AB, Mustafa B, Ikram J, Khan MH, Cremer PC, et al. Comparative efficacy and safety of colchicine and anti-interleukin-1 agents in recurrent pericarditis: a pairwise and network meta-analysis of randomized controlled trials. J Am Heart Assoc. 2025;14(13): e041007. https://doi.org/10.1161/JAHA.125.041007

50. Zuriaga MA, Yu Z, Matesanz N, Truong B, RamosNebleBL, Asensio-López MC, et al. Colchicine prevents accelerated atherosclerosis in TET2-mutant clonal haematopoiesis. Eur Heart J. 2024;45(43):4601–4615. https://doi.org/10.1093/eurheartj/ehae546

51. Mishaly D, Fishbein I, Moscovitz D. Site-specific delivery of colchicine in rat carotid artery model of restenosis. JControl Release. 1997;45:65–73. https://doi.org/10.1016/S0168-3659(96)01546-5

52. Doorty KB, Golubeva TA, Gorelov AV, Rochev YA, Allen LT, Dawson KA, et al. Poly(N-isopropylacrylamide) co-polymer films as potential vehicles for delivery of an antimitotic agent to vascular smooth muscle cells. Cardiovasc Pathol. 2003;12(2):105–110. https://doi.org/10.1016/s1054-8807(02)00165-5

53. Di Francesco V, Di Francesco M, Palomba R, Brahmachari S, Decuzzi P, Ferreira M. Towards potent anti-inflammatory therapies in atherosclerosis: the case of methotrexate and colchicine combination into compartmentalized liposomes. J Drug Deliv Sci Technol. 2023;80:104179. https://doi.org/10.1016/j.jddst.2023.104179

54. Dubashynskaya NV, Golovkin AS, Kudryavtsev IV, Prikhodko SS, Trulioff AS, Bokatyi AN, et al. Mucoadhesive cholesterolchitosan self-assembled particles for topical ocular delivery of dexamethasone. Int J Biol Macromol. 2020;158:811–818. https://doi.org/10.1016/j.ijbiomac.2020.04.251

55. Khammar Z, Berrady R, Boukhrissa A, Lamchachti L, Amrani K, Rabhi S, et al. Intracardiac thrombosis in Behçet disease: clinical presentation and outcome of three cases. J Mal Vasc. 2011;36(4):270–273. https://doi.org/10.1016/j.jmv.2011.04.002

56. Bagnato JD, Eilers AL, Horton RA, Grissom CB. Synthesis and characterization of a cobalamin-colchicine conjugate as a novel tumor-targeted cytotoxin. J Org Chem. 2004;69(26):8987–8996. https://doi.org/10.1021/jo049953w

57. Lagnoux D, Darbre T, Schmitz ML, Reymond JL. Inhibition of mitosis by glycopeptide dendrimer conjugates of colchicine. Chemistry. 2005;11(13):3941–3950. https://doi.org/10.1002/chem.200401294

58. Svirshchevskaya EV, Gracheva IA, Kuznetsov AG, Myrsikova EV. Antitumor activity of furanoallocolchicinoid-chitosan conjugate. Med Chem. 2016;6. https://doi.org/10.4172/2161-0444.1000401

59. Sil S, Ghosh R, Sanyal M, Guha D, Ghosh T. A comparison of neurodegeneration linked with neuroinflammation in different brain areas of rats after intracerebroventricular colchicine injection. J Immunotoxicol. 2016;13(2):181–190. https://doi.org/10.3109/1547691X.2015.1030804

60. Saini N, Singh D, Sandhir R. Bacopa monnieri prevents colchicine-induced dementia by anti-inflammatory action. Metab Brain Dis. 2019;34(2):505–518. https://doi.org/10.1007/s11011-018-0332-1

61. Essawy AE, Abdou HM, Ibrahim HM, Bouthahab NM. Soybean isoflavone ameliorates cognitive impairment, neuroinflammation, and amyloid β accumulation in a rat model of Alzheimer's disease. Environ Sci Pollut Res Int. 2019;26(25):26060–26070. https://doi.org/10.1007/s11356-019-05862-z