From the Guidelines
Colchicine is not currently recommended for primary prevention of cardiovascular disease in the general population. While recent research, such as the 2024 guideline for the primary prevention of stroke 1, has shown some promise for colchicine in reducing the risk of cardiovascular events, the evidence is not strong enough to support its routine use in people without established cardiovascular disease. Colchicine, traditionally used for gout and pericarditis, works by reducing inflammation through inhibition of neutrophil function and inflammasome activation. The anti-inflammatory properties that make it effective for these conditions have generated interest in its potential cardiovascular benefits, as inflammation plays a key role in atherosclerosis. However, colchicine can cause significant side effects, including gastrointestinal symptoms (nausea, vomiting, diarrhea), bone marrow suppression, and drug interactions, as noted in studies on its use and management 1.
For primary prevention of cardiovascular disease, established approaches remain the standard of care, including:
- Lifestyle modifications (healthy diet, regular exercise, smoking cessation)
- Management of traditional risk factors (hypertension, diabetes, dyslipidemia)
- When indicated, medications like statins or aspirin based on individual risk assessment. It's essential to weigh the potential benefits of colchicine against its risks and consider alternative, evidence-based strategies for primary prevention of cardiovascular disease. The most recent and highest quality study, such as the 2024 guideline 1, should guide clinical decision-making, prioritizing morbidity, mortality, and quality of life outcomes.
From the Research
Colchicine for Primary Prevention of Cardiovascular Disease
- The use of colchicine for primary prevention of cardiovascular disease has been studied in several trials, with mixed results 2, 3.
- A 2016 Cochrane review found that colchicine may have substantial benefits in reducing myocardial infarction in selected high-risk populations, but the uncertainty about the size of the effect on survival and other cardiovascular outcomes is high 2.
- A 2025 Cochrane review found that colchicine may reduce all-cause mortality compared to placebo in primary prevention, but the evidence is very uncertain (RR 0.68,95% CI 0.51 to 0.91) 3.
- The same review found that colchicine may result in little to no difference in non-fatal myocardial infarction, and may not reduce the incidence of stroke, but the evidence is very uncertain 3.
- A 2017 study found that colchicine-treated familial Mediterranean fever patients had normal arterial stiffness, suggesting a possible cardiovascular protective role of colchicine 4.
Adverse Events
- Colchicine has been associated with gastrointestinal side effects, including diarrhea, based on low-quality evidence 2, 3.
- The 2025 Cochrane review found that colchicine may increase the incidence of diarrhea compared to placebo (RR 3.99,95% CI 1.44 to 11.06) and usual care (RR 3.32,95% CI 1.56 to 7.03) 3.