- Colchicine is a medication typically used to help treat gout, mainly by treating pain and inflammation.
- A recent review found that low dose colchicine may help prevent heart attacks and strokes in individuals who already have cardiovascular disease.
- The review also found that colchicine likely doesn’t decrease risk for death or have an impact on rates of coronary revascularization, which is a procedure that helps to reestablish blood supply to the heart.
The review and meta-analysis, published in the Cochrane Library, focused on adults who had recently experienced a heart attack or stroke or already had stable cardiovascular disease.
The review found that low dose colchicine helps reduce the risk of heart attack and stroke, identifying another potential strategy to help with the prevention of these conditions.
Researchers in the current review wanted to evaluate how colchicine could possibly help with the prevention of cardiovascular events like heart attacks, as well as colchicine’s potential harms. While previous research has shown a benefit, additional trials have been done that researchers wanted to take into account.
The researchers primarily used three significant databases to identify relevant randomized controlled trials. They focused on the use of colchicine for at least six months among individuals with stable cardiovascular disease or who had recently experienced a heart attack, acute coronary syndrome, stroke, or a high risk transient ischaemic attack. Thus, they were able to focus on the benefits of long-term use.
They considered several outcomes, including all-cause mortality, stroke, heart attack, and serious adverse events. Serious adverse events included components like hospitalization and death. As they gathered relevant data, researchers considered possible study bias for the outcomes of heart attack, serious adverse events, cardiovascular mortality, all-cause mortality, coronary revascularization, and stroke.
Researchers performed a meta-analysis. The meta-analysis included twelve studies, including data from almost 23,000 individuals. Some of this data was from a previous review on the subject, but much was from newer research. About half of these participants received colchicine, and the other half were part of the control group.
About 30% of the studies focused on low-dose colchicine use among participants who had chronic, stable coronary artery disease. Almost 57% of the studies focused on the use of colchicine during acute hospitalization for acute coronary syndrome or within the month following its onset. Other studies focused on the use of colchicine after stroke.
Lower heart attack and stroke risk
Overall, researchers found with moderate certainty of evidence that colchicine probably does not affect the risk of all-cause death and death from cardiovascular disease.
It also likely doesn’t impact rates of coronary revascularization, a medical procedure that helps restore blood flow to the heart. For the coronary revascularization component of the study, researchers looked at two main procedures:
However, they did find that colchicine helped to decrease the risk of heart attack and stroke, and that there was a high certainty of evidence for both of these components. This translates to nine fewer people per 1,000 experiencing a heart attack and eight fewer people per 1,000 experiencing a stroke.
They also found with high certainty of evidence that colchicine likely doesn’t increase the chances of experiencing serious adverse events.
However, the results also indicated that people on colchicine may be more likely to experience gastrointestinal adverse events like nausea, but these events may be mild and not last long.
When researchers did their sensitivity analysis, they focused on studies with “an overall low risk of bias for all outcomes.” The results were similar, but they did find “slightly more statistical uncertainty was observed for stroke.”
This review, despite its limitations, offers valuable insights into the benefits of colchicine. However, it has its limitations.
First of all, the specific research methods, analysis methods, focus, and eligibility criteria used have their limits. For example, researchers chose not to focus on colchicine’s adverse effects separately, instead only focusing on the adverse effects discussed in the studies. They explain that they “did not specifically search for adverse events of the intervention.” So, researchers acknowledge that “there could be relevant evidence for this outcome that is not included in the review.”
It’s most likely that effect estimates and confidence could change for results where there was a moderate certainty of evidence.
How researchers chose to handle possible bias, such as by not excluding studies from the meta-analysis based on bias risk, could have also influenced results. However, researchers note that “results were robust to variations in the risk of selection, performance, and attrition bias from individual studies.”
The studies had limitations and differences from each other, too. For example, there was high heterogeneity when it came to examining gastrointestinal adverse events. Just a little less than 80% of the participants in the meta-analysis data were male, so more data on females may be an important part of future research.
Future research may also need to focus on specific age ranges and consider even longer follow-up times, since the maximum follow-up timeframe was just over six and a half years. More data on individuals’ inflammation may be a helpful component of future research as well.
Because this review focused on specific individuals, such as those who had experienced a recent heart attack, it limits how much the results can apply to other individuals. Researchers also wanted to evaluate outcomes of all-cause hospitalizations and quality of life, but none of the studies had this information.
Two review authors received funding from foundations. Several authors also declared conflicts of interest.
It’s also important to note that, although this review highlights the noted benefits of colchicine, it does not mean that it should be used in all individuals. Cardiologist at Vital Heart and Vein, Patrick Kee, MD, PhD, who was not involved in the study, noted the following:
“Colchicine should be reserved for patients at very high risk, given its narrow therapeutic index and potential for drug-drug interactions, and should be avoided in those with severe renal or hepatic impairment or blood dyscrasias. The ideal candidate for low-dose colchicine is a patient with chronic, stable coronary artery disease. The evidence does not support initiating colchicine during an acute coronary syndrome, where it has shown no benefit.”
The review supports the possible preventative benefits of colchicine; however, the best approach will be on a case-by-case basis and tailored to the individual.
“Colchicine represents one of the most impactful additions to the secondary prevention toolbox since high intensity statins. Its ability to reduce MI (myocardial infarction/heart attack) and stroke events — on top of contemporary lipid-lowering therapy — positions it as a practical, evidence-based option for clinicians managing patients with high residual inflammatory risk,” Kee said.
Cheng-Han Chen, MD, board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was also not involved in the study, offered a similar sentiment.
“While men are more likely to have a heart attack than women, a medicine like colchicine should benefit both groups equally well as far as we know. For people with known heart disease at risk for future cardiovascular events, colchicine can potentially be helpful in preventing future events,” he told Medical News Today.
“Used judiciously, colchicine offers an accessible, mechanistically targeted, and clinically validated therapy that meaningfully improves outcomes in chronic atherosclerotic cardiovascular disease.”
— Patrick Kee, MD, PhD
