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Low-Dose Colchicine in Post-Myocardial Infarction Recovery and Long-Term Cardiovascular Health: A Systematic Review

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Abstract

Introduction

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Persistent inflammation after MI contributes to adverse remodeling and recurrent events. Low-dose colchicine, traditionally used for gout and pericarditis, has been investigated as an adjunct to standard therapy to improve post-MI and coronary artery disease outcomes. This systematic review aimed to synthesize evidence from recent clinical trials evaluating the efficacy and safety of low-dose colchicine in post-MI recovery as well as long-term cardiovascular risk reduction.

Methodology

This PROSPERO-registered review (CRD42024605829) followed PRISMA guidelines. PubMed/MEDLINE, Embase, Google Scholar, Cochrane Library, and Web of Science were searched to July 2025 for randomized controlled trials of low-dose colchicine in adults with MI or coronary artery disease (CAD). Eligible studies reported short-term (≤ 12 months) and/or long-term (> 12 months) cardiovascular outcomes and safety. Data extraction prioritized primary efficacy endpoints and adverse events.

Results

Eight trials involving 11,057 participants met the inclusion criteria. COLCOT showed that colchicine after MI reduced the composite primary endpoint versus placebo (5.5% vs. 7.1%, HR 0.77, P = 0.02). In a prespecified COLCOT analysis, initiation within 3 days post-MI yielded the greatest benefit over placebo (4.3% vs. 8.3%). A study reported lower major adverse cardiovascular events (MACE) over 6 months after acute coronary syndrome (6.7% vs. 21.7%, HR 1.64, 95% CI 1.31–2.05, P = 0.001). A COVERT-MI extension found no difference in 1-year MACE but higher left ventricular thrombus incidence with colchicine. The LoDoCo2 trial in chronic coronary artery disease found significant long-term MACE reduction (6.8% vs. 9.6%, HR 0.69, 95% CI 0.57– 0.83, P < 0.001). By contrast, LoDoCo-MI observed no significant CRP reduction in CRP 30 days after acute MI. Gastrointestinal intolerance was the most frequent adverse event. Serious adverse events were rare.

Conclusion

High-quality evidence from large RCTs indicates that early, prolonged low-dose colchicine can reduce recurrent cardiovascular events after MI and in CAD, with a generally acceptable safety profile. Benefits appear most pronounced when treatment is initiated within days of the index event in MI; however, results are not uniformly consistent across all populations and follow-up durations. Further research is needed to address long-term safety and optimal timing of initiation.

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Data Availability

No datasets were generated or analysed during the current study.

Code Availability

Not Applicable.

Abbreviations

MI :

Myocardial Infarction

NLRP3 :

NOD-, LRR-, and Pyrin Domain-Containing Protein 3

MACE :

Major Adverse Cardiovascular Events

STEMI :

ST-Elevation Myocardial Infarction

NSTEMI :

Non-ST-Elevation Myocardial Infarction

CRP :

C-Reactive Protein

CAD :

Coronary Artery Disease

CVD :

Cardiovascular Disease

NLR :

Neutrophil-to-Lymphocyte Ratio

TNF :

Tumor Necrosis Factor

IL :

Interleukin

ACEi :

Angiotensin-Converting Enzyme Inhibitors

CCBs :

Calcium Channel Blockers

PCI :

Percutaneous Coronary Intervention

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Authors and Affiliations

  1. Department of Internal Medicine, Northwestern Medicine McHenry Hospital, McHenry, IL, USA

    Ikponmwosa Jude Ogieuhi & Boluwaduro Abasiekem Adeyemi

  2. Faculty of Clinical Sciences, University of Calabar, Calabar, Nigeria

    Chidera Stanley Anthony

  3. Ladoke Akintola University of Technology, Ogbomosho, Nigeria

    Victor Oluwatomiwa Ajekiigbe

  4. Ternopil State Medical University, Ternopil, Ukraine

    Ifeoluwa Sandra Bakare

  5. Department of Cardiovascular Services, Queen Elizabeth Hospital, Bridgetown, St. Michael, Barbados

    Kristen Callender

  6. Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, University of Lagos, Ikeja, Nigeria

    Ganiyat Adekemi Adeshina

  7. Olabisi Onabanjo University, Remo-Ilesan, Nigeria

    Olufemi Akinmeji

  8. Department of Internal Medicine, Aurora Health Care, Milwaukee, WI, USA

    Chimezirim Ezeano

  9. Sinai Hospital of Baltimore, Baltimore, MD, USA

    Esther Bajo Tetteh

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  1. Ikponmwosa Jude Ogieuhi
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Contributions

IJO and KC conceptualized the study and reviewed the final manuscript. IJO prepared Table 1, and CSA prepared Table 2. CSA conducted the literature search. VOA prepared Fig. 1. All authors (IJO, CSA, VOA, ISB, KC, BAA, GAA, OA, CE, EBT) reviewed and approved the final manuscript.

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Correspondence to Ikponmwosa Jude Ogieuhi.

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Highlights

• Colchicine’s anti-inflammatory role and its benefits in myocardial infarction when given in low dose.

• The overall benefits of colchicine in patients with CVD exceedingly outweigh the mild side effects that have been linked to its use.

• Colchicine is a promising adjunctive therapy in the management of myocardial infarction, and future studies should focus on its efficacy and potential for a more diverse patient population.

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Ogieuhi, I.J., Anthony, C.S., Ajekiigbe, V.O. et al. Low-Dose Colchicine in Post-Myocardial Infarction Recovery and Long-Term Cardiovascular Health: A Systematic Review. SN Compr. Clin. Med. 7, 305 (2025). https://doi.org/10.1007/s42399-025-02056-2

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