Colchicine benefits are overestimated and current recommendations are too strong: pros and cons

Inflammation is a key determinant for the development and progression of atherosclerotic cardiovascular disease (ASCVD), strongly contributing to the so-called “residual cardiovascular (CV) risk”. A large number of clinical trials investigating different agents were conducted before colchicine emerged as the first anti-inflammatory drug to be recommended by guidelines for the management of acute (ACS) and chronic coronary syndromes (CCS). However, despite a strong mechanistic rationale and supporting clinical data, colchicine has never received a Class I recommendation. Recently, a large randomised clinical trial (RCT) in patients who had myocardial infarction (MI) has yielded neutral results, which are not consistent with previous findings. This discrepancy has raised concerns about the true clinical benefit of colchicine in patients with ASCVD, particularly in light of heterogeneity across trials and potential safety concerns. Whether current guideline recommendations are entirely justified or the benefits of colchicine have been overestimated remains a matter of debate.

Pros

Kevin R. Bainey, MD, MSc, FRCPC, FACC

In patients presenting with an acute coronary syndrome, evidence-based secondary prevention pharmacotherapeutic agents have reduced cardiovascular death or MI. Yet, despite these...