Colchicine for Prevention of Major Adverse Cardiovascular Events: A systematic review and meta-analysis of randomized clinical trials

Aims Inflammation is a main pathophysiological driver in atherosclerotic cardiovascular diseases (ASCVD). Low-dose long-term colchicine for secondary prevention in patients with established ASCVD has been studied in multiple randomized trials in the last decade. This meta-analysis aimed to evaluate the efficacy and safety of long-term low-dose colchicine for secondary prevention in patients with established ASCVD. Methods We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate studies reporting long-term outcomes in patients with ASCVD. We systematically searched PubMed, EMBASE and Scopus databases for relevant studies up to December 1, 2024. The primary outcome was the occurrence of Major Adverse Cardiovascular Events (MACE), a composite of cardiovascular death (CVD), myocardial infarction (MI) and stroke. Random-effects models were used to calculate pooled risk ratios (RR). Results Ten randomized clinical trials enrolling 22532 patients were identified. Addition of colchicine to standard medical treatment in patients with established ASCVD reduced the risk for MACE by 27% (RR 0.73, 95% CI 0.57 – 0.95), with a number needed to treat of 52. Colchicine was found to significantly reduce the risk of myocardial infarction (RR 0.83, 95% CI 0.72 - 0.96) and coronary revascularization (RR 0.79, 95% CI 0.65 - 0.94). There were no significant differences between the two groups concerning cardiovascular and non-cardiovascular mortality, risk of serious gastrointestinal events, infections requiring hospitalization and cancer. Conclusions These findings support the use of long-term low-dose colchicine for secondary prevention of MACE in clinical practice.