Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week (JACC August 2023-2)-Article: Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week

Article: Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week

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In cardiovascular medicine, low-dose colchicine (0.5 mg daily) has demonstrated notable efficacy in reducing major adverse cardiovascular events in patients with coronary artery disease already on standard therapies, including statins. Evidence shows that inflammation, measured by high-sensitivity C-reactive protein (hsCRP), is a more significant predictor of cardiovascular death and all-cause mortality than LDL cholesterol (LDL-C). Clinical trials such as LoDoCo2 and COLCOT revealed that low-dose colchicine decreased adverse cardiovascular events by 31% among stable atherosclerosis patients and by 23% among those who had a recent myocardial infarction. <br /><br />The benefits of colchicine surpass those seen with adjunctive lipid-lowering agents like PCSK9 inhibitors. Colchicine's efficacy is notable in patients with hsCRP ≥2 mg/L, despite aggressive lipid-lowering treatments. However, colchicine is contraindicated for patients with significant renal or liver dysfunction and requires caution when used alongside certain medications (e.g., clarithromycin, ketoconazole).<br /><br />Colchicine operates by mitigating inflammation through pathways involving interleukin-1β and interleukin-6, key in atherosclerotic progression and plaque stability. Recent approval by the U.S. FDA (June 2023) endorses low-dose colchicine for reducing risks of myocardial infarction, stroke, coronary revascularization, and cardiovascular death in patients with established atherosclerotic disease or multiple risk factors.<br /><br />Clinical practice suggests that routine measurement of hsCRP can help identify patients with residual inflammatory risk, prompting the potential addition of colchicine to their regimen. The integration of lipid-lowering and inflammation-inhibiting therapies might become standard practice, optimizing secondary prevention strategies against cardiovascular events and aligning with the dual approach to address residual cholesterol and inflammatory risk. Despite gastrointestinal side effects early in the treatment, long-term colchicine use has shown a favorable safety profile, including no notable increase in adverse outcomes such as infection or cancer. In conclusion, low-dose colchicine is a promising adjunctive therapy for improving cardiovascular outcomes in high-risk atherosclerosis patients.

Keywords

cardiovascular medicine

low-dose colchicine

coronary artery disease

inflammation

high-sensitivity C-reactive protein

clinical trials

atherosclerosis

myocardial infarction

FDA approval

secondary prevention