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Open Access
CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2724-4543
Review Article

Current Evidence and Future Directions for Colchicine in the Prevention of Atherosclerotic Cardiovascular Disease

Authors

  • Aimée M.H. van Zelm

    1   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

  • Aernoud T.L. Fiolet

    2   Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands

  • Robert J. Hinchliffe

    3   Department of Vascular Surgery, University of Bristol, Bristol, United Kingdom

  • Shirley Jansen

    4   Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    5   Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia

  • Martin Teraa

    1   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

  • Noel C. Chan

    6   Department of Medicine, McMaster University, Ontario, Canada
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Graphical Abstract

Abstract

Chronic inflammation plays a key role in the development and progression of atherosclerotic cardiovascular disease (ASCVD) and its complications. Despite the use of blood pressure-, lipid-, and glucose-lowering therapies as well as antithrombotic agents, the lifetime residual cardiovascular (CV) risk in patients with ASCVD remains high. Because chronic inflammation remains an unaddressed risk factor, anti-inflammatory therapy has the potential to further lower residual CV risk in these patients. Low-dose colchicine (0.5 mg daily) has emerged as a promising low-cost oral anti-inflammatory therapy for this indication. In patients with chronic coronary syndrome (CCS), low-dose colchicine was well-tolerated and reduced the risk of myocardial infarction, stroke, coronary revascularization, and CV death. However, trials in patients with acute coronary syndrome (ACS) yielded conflicting results, and two trials in patients with ischemic stroke did not show a benefit. In patients with peripheral artery disease (PAD), preliminary observational data suggested a potential benefit, and a randomized trial is currently underway to examine its efficacy in reducing CV and limb events. The long-term safety data for low-dose colchicine in ASCVD are reassuring. Although pooled data from trials in ASCVD show a small (0.55%) absolute increase in the risk of hospitalization for gastrointestinal events, adverse signals were not observed for serious infection, cancer, or severe myotoxicity. In this article, we review the clinical studies of colchicine that examined its risk–benefit for the prevention of CV events in patients with ASCVD, discuss clinical and research implications, and highlight knowledge gaps.

Keywords

colchicine - inflammation - cardiovascular disease - prevention - atherosclerosis


Publication History

Received: 02 May 2025

Accepted: 13 October 2025

Accepted Manuscript online:
23 October 2025

Article published online:
07 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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