Efficacy and safety of colchicine in patients with coronary artery disease: An updated meta-analysis of randomized controlled trials

Mushood Ahmed¹, Tallal Mushtaq Hashmi¹, Aimen Shafiq², Hadiah Ashraf¹, Hritvik Jain³, Mohammed Y Khanji⁴, Rui Providência^{4

5}, Anwar A Chahal^{6

7

8}, Jamal S Rana^{9

10}, Muzammil Farhan¹¹, Raheel Ahmed^{11

12}, Marat Fudim^{13

14}, Gregg C Fonarow¹⁵

Affiliations

¹ Rawalpindi Medical University, Rawalpindi, Pakistan.
² Dow University of Health Sciences, Karachi, Pakistan.
³ All India Institute of Medical Sciences, Jodhpur, India.
⁴ Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.
⁵ Cardiovascular Epidemiology & Evidence Synthesis, Institute of Health Informatics, University College London, London, UK.
⁶ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
⁷ Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA.
⁸ NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
⁹ Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA.
¹⁰ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹¹ National Heart and Lung Institute, Imperial College London, London, UK.
¹² Department of Cardiology, Royal Brompton Hospital, London, UK.
¹³ Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
¹⁴ Duke Clinical Research Institute, Durham, NC, USA.
¹⁵ Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.

PMID: 41019029
PMCID: PMC12465056
DOI: 10.1016/j.ahjo.2025.100610

Efficacy and safety of colchicine in patients with coronary artery disease: An updated meta-analysis of randomized controlled trials

Mushood Ahmed et al. Am Heart J Plus. 2025.

. 2025 Sep 13:59:100610.

doi: 10.1016/j.ahjo.2025.100610. eCollection 2025 Nov.

Authors

Affiliations

¹ Rawalpindi Medical University, Rawalpindi, Pakistan.
² Dow University of Health Sciences, Karachi, Pakistan.
³ All India Institute of Medical Sciences, Jodhpur, India.
⁴ Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.
⁵ Cardiovascular Epidemiology & Evidence Synthesis, Institute of Health Informatics, University College London, London, UK.
⁶ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
⁷ Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA.
⁸ NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK.
⁹ Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA.
¹⁰ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹¹ National Heart and Lung Institute, Imperial College London, London, UK.
¹² Department of Cardiology, Royal Brompton Hospital, London, UK.
¹³ Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
¹⁴ Duke Clinical Research Institute, Durham, NC, USA.
¹⁵ Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.

PMID: 41019029
PMCID: PMC12465056
DOI: 10.1016/j.ahjo.2025.100610

Abstract

Background: Inflammation is associated with an increased risk of adverse cardiovascular events in patients with coronary artery disease (CAD). Colchicine is an anti-inflammatory drug that can be used to improve clinical outcomes in patients with CAD.

Methods: A systematic literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane CENTRAL up to August 2025 to identify randomized controlled trials (RCTs) that reported clinical outcomes with the use of colchicine in CAD. Data for outcomes was extracted and summary estimates were generated using a random effects model.

Results: 16 RCTs were included reporting data for 20,601 patients. The pooled analysis demonstrated a non-significant difference between colchicine and control groups for reducing all-cause death (RR: 0.97; 95 % CI, 0.78-1.22), cardiovascular death (RR: 0.98; 95 % CI, 0.79-1.21), and stroke (RR: 0.67; 95 % CI, 0.39-1.15). However, colchicine significantly reduced the risk of myocardial infarction (RR: 0.74; 95 % CI, 0.59-0.93), and ischemia-driven revascularization (RR = 0.72; 95 % CI, 0.53-0.99) at the expense of an increased risk of gastrointestinal adverse events (RR = 1.83; 95 % CI, 1.38-2.43) as compared to control.

Conclusion: Colchicine does not reduce the relative risk of all-cause and cardiovascular death in patients with CAD. However, it can reduce the risk of myocardial infarction and ischemia drive revascularization. Additional trial data are required to confirm these findings.

Keywords: Colchicine; Coronary artery disease; Inflammation; meta-analysis.

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Conflict of interest statement

Dr. Fonarow reported receiving personal fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer outside the submitted work. Dr. Fudim reported receiving personal fees from Alleviant, Ajax, Alio Health, Alleviant, Artha, Audicor, Axon Therapies, Bayer, Bodyguide, Bodyport, Boston Scientific, Broadview, Cadence, Cardioflow, Cardionomics, Coridea, CVRx, Daxor, Deerfield Catalyst, Edwards LifeSciences, Echosens, EKO, Feldschuh Foundation, Fire1, FutureCardia, Galvani, Gradient, Hatteras, HemodynamiQ, Impulse Dynamics, Intershunt, Medtronic, Merck, NIMedical, NovoNordisk, NucleusRx, NXT Biomedical, Orchestra, Pharmacosmos, PreHealth, Presidio, Procyreon, ReCor, Rockley, SCPharma, Shifamed, Splendo, Summacor, SyMap, Verily, Vironix, Viscardia, and Zoll; and receiving grants from the National Institutes of Health, Doris Duke, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Fig. 1**
PRISMA flowchart depicting the screening and study selection process.

**Fig. 2**
Forest plots of A) All-cause death, (B) Cardiovascular death, (C) Myocardial infarction.

**Fig. 3**
Forest plots for (A) Stroke, and (B) Ischemia driven revascularization,

**Fig. 4**
Forest plots for (A) Gastrointestinal adverse events and (D) Discontinuation/withdrawal.

See this image and copyright information in PMC

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Efficacy and safety of colchicine in patients with coronary artery disease: An updated meta-analysis of randomized controlled trials

Affiliations

Efficacy and safety of colchicine in patients with coronary artery disease: An updated meta-analysis of randomized controlled trials

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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