Colchicine therapy for coronary artery disease

Low‑dose colchicine (0.5 mg once daily) is now an evidence‑based option to lower recurrent cardiovascular events in patients with stable coronary artery disease (CAD) or after a recent myocardial infarction (MI), provided it is tolerated. The ACC 2025 guideline, together with ESC 2024 and CCS recommendations, endorse its use in selected high‑risk patients as an add‑on for residual inflammatory risk (elevated hs‑CRP, recurrent angina or PCI) after optimal statin, antiplatelet, blood‑pressure and lipid therapy. The benefit is derived from two large randomized trials—COLCOT (post‑MI) and LoDoCo2 (chronic CAD)—which showed a 23‑31 % relative risk reduction in a composite of MI, stroke and ischemia‑driven revascularization, with an absolute benefit modest enough to give a number‑needed‑to‑treat of roughly 35‑70 over 2‑3 years. No clear mortality reduction was observed, and LoDoCo2 noted a small, uncertain increase in non‑cardiovascular death. Common adverse effects are gastrointestinal upset; rare myotoxicity can occur, especially when combined with high‑dose statins or in chronic kidney disease. Colchicine should be avoided in significant renal or hepatic failure and with strong CYP3A4/P‑gp inhibitors such as clarithromycin, certain azoles, or cyclosporine. Routine laboratory monitoring beyond standard CAD care is not required, but patients should be counseled to report persistent diarrhea, muscle pain, or weakness, at which point the drug should be stopped.