In patients with type 2 diabetes and recent MI, colchicine reduced a composite CV outcome at 23 mo

Based on this and previous trials, low-dose colchicine should be considered as anti-inflammatory therapy for secondary prevention after myocardial infarction (MI) in patients at high risk for cardiovascular (CV) events, according to an ACP Journal Club commentary.

A randomized trial of colchicine, at a dose of 0.5 mg daily, after myocardial infarction found a reduction in adverse cardiovascular (CV) outcomes in the subgroup of patients with type 2 diabetes. The composite outcome included CV death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina requiring coronary revascularization. Rates were 8.7% among patients in the colchicine group and 13.1% in the placebo group.

The study was published by Diabetes Care on Jan 5. The following commentary by Eric R. Bates, MD, FACP, was published in the ACP Journal Club section of Annals of Internal Medicine on May 7.

Colchicine is a well-known anti-inflammatory agent used to treat acute gout, familial Mediterranean fever, Behçet disease, and pericarditis. In recent trials, it reduced composite (but not individual) ischemic events in patients with chronic coronary artery disease and recent myocardial infarction. In June 2023, the U.S. Food and Drug Administration approved low-dose (0.5 mg/d) colchicine for secondary CV prevention. The 2021 European Society of Cardiology guidelines also support colchicine for secondary prevention, particularly in patients with uncontrolled risk factors or recurrent events despite optimal medical therapy.

In this prespecified analysis from the COLCOT trial by Roubille and colleagues, 959 of 4745 patients had type 2 diabetes, a subgroup with more pronounced vascular inflammation and higher risk for recurrent ischemic events. The benefit in patients who had diabetes was greater than in patients without diabetes, supporting the concept that inflammation-reducing therapy might have a greater benefit in subgroups of patients with higher risk after myocardial infarction. The absolute number of composite events was 40 vs. 65 in the colchicine and placebo groups, respectively, so the analysis is underpowered for clinical events and the magnitude of benefit may be lower in clinical practice. However, previous studies have shown consistent therapeutic benefit with low-dose colchicine for coronary disease.

The convenience, safety, and cost-effectiveness of low-dose colchicine as anti-inflammatory therapy for secondary prevention should be considered for high-risk patients with coronary disease and preserved renal and hepatic function who are not treated with CYP3A4/P-glycoprotein inhibitors. Until additional studies clarify whether routine use is indicated, a C-reactive protein level >2 mg/L in patients receiving maximal medical therapy that includes a statin could be used as a potential screening test to select high-risk patients.