In short Article

Colchicine for coronary heart disease


Is it advisable to prescribe a low dose of colchicine (0.5 mg a day) as part of the secondary prevention of coronary heart disease? Several studies have assessed the efficacy of colchicine for this indication, and some meta-analyses have recently been published. However, the use of colchicine in the secondary prevention of coronary heart disease has not yet been included in the guidelines. Research has shown that the use of low-dose colchicine reduces the risk of major adverse cardiovascular events (MACEs) by about a third. In addition, colchicine reduces the risk of in-stent restenosis in bare-metal stents by more than half. The downside is that non-cardiovascular mortality appears to be increased by 50%. On the other hand, this increase is compensated by an equal decrease in cardiovascular mortality, so that the overall mortality remains the same. There have been conflicting reports about the risk of gastro-intestinal adverse effects. One advantage is that colchicine treatment is cheap, as various nonproprietary products are available.

  • Colchicine has a favourable effect on the endpoint of major cardiovascular events but does not reduce overall mortality.
  • The main role of colchicine is the prevention of in-stent restenosis when using bare-metal stents.
  • The most common adverse effects at the low dosage used are gastro-intestinal and are mild to moderately severe.
  • In view of the narrow therapeutic index, however, the adverse effects need to be carefully monitored, and the same goes for possible interactions with other drugs frequently used in this patient population.
  • Low-dose colchicine is a safe, effective and cheap supplement to the current standard treatment for the secondary prevention of coronary heart disease.

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Authors

  • Rutger A. Middelburg
  • Margriet H. Veerman