Colchicine in Cardiovascular Disease: In-Depth Review

Spyridon G. Deftereos, MD, PhD; Frans J. Beerkens, MD; Binita Shah, MD, MS; George Giannopoulos, MD, PhD; Dimitrios A. Vrachatis, MD, MS, PhD; Sotiria G. Giotaki, MD; Gerasimos Siasos, MD, MS, PhD; Johny Nicolas, MD; Clare Arnott, MBBS, PhD; Sanjay Patel, MBBS, PhD; Mark Parsons, MD, PhD; Jean-Claude Tardif, MD; Jason C. Kovacic, MD, PhD; George D. Dangas, MD, PhD


Circulation. 2022;145(1):61-78. 

In This Article

Abstract and Introduction


Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease.


Colchicine has carried many names and been used for centuries.[1,2] The botanical alkaloid compound is derived from the flower Colchicum autumnale, a medicinal plant described as early as 1550 BC in the Egyptian Ebers Papyrus used to treat pain and swelling. The plant and therapeutic lend their names to the ancient Colchis (home to mythological sorceresses Medea and Circe), roughly corresponding to the current republic of Georgia. Through the years, colchicine has been frequently described both for its medicinal use in gout (as early as 129–200 CE) as well as its poisonous effects at high doses. Having survived years of scrutiny, colchicine use is rapidly expanding as it is currently considered for a variety of inflammatory conditions. It carries Food and Drug Administration–approved indications for prevention and treatment of gout flares, as well as treatment of familial Mediterranean fever (FMF). It is also used off label for other inflammatory conditions including pericarditis, calcium pyrophosphate disease, and Adamantiades-Behcet's syndrome.[3–6] Over the years, many studies have shown that inflammation may significantly contribute to a wider variety of pathologies than traditionally thought, including cardiovascular diseases such as atherosclerosis and atrial fibrillation (AF). Therefore, anti-inflammatory strategies are now being carefully examined for potential broader application across a range of cardiovascular diseases. Given wide availability, low cost, and a rather favorable side-effect (tolerability) profile, colchicine has emerged as a potentially useful oral cardiovascular treatment targeting the inflammatory axis. We will review the role inflammation plays in cardiovascular disease, including various anti-inflammatory strategies, and then examine past and current evidence about colchicine in cardiovascular disease.