Long on Meds Blog
Can Low-Dose Colchicine Help Protect Against Cardiovascular Disease?
Colchicine is an old anti-inflammatory drug traditionally used for gout and familial Mediterranean fever. It is now also an FDA-approved cardiovascular medication. Large randomized trials have shown that low-dose colchicine can reduce cardiovascular events in people with coronary disease, providing an unusually strong example of an old generic medication being repurposed for disease prevention.
Why did I start taking colchicine?
My introduction to colchicine was through gout. I knew firsthand how effectively it could suppress the intense inflammation of a gout attack. After I began taking allopurinol to control my uric acid, I became interested in whether a much smaller daily dose of colchicine might provide broader anti-inflammatory benefits.
I was particularly interested in vascular protection because I already had vascular disease and was taking conventional preventive medications, including a statin, blood pressure medications, and low-dose aspirin. I was looking for additional protection, not a replacement for proven cardiovascular therapy.
What convinced me that long-term colchicine might be reasonable?
I first looked at the long experience with colchicine in people with familial Mediterranean fever, who may take the medication continuously for decades. That gave me useful information about the feasibility and safety of chronic treatment.
Then cardiovascular evidence began appearing. In a randomized trial of people with diabetes receiving coronary stents, colchicine substantially reduced in-stent restenosis. That reinforced my suspicion that suppressing inflammation might protect arteries as well as joints.
I began taking low-dose colchicine for vascular protection before it received an FDA cardiovascular indication.
Did later cardiovascular trials support that idea?
Yes.
In COLCOT, 4,745 patients who had recently suffered a myocardial infarction were randomized to colchicine 0.5 mg daily or placebo. Cardiovascular events occurred in 5.5% of the colchicine group versus 7.1% with placebo.
LoDoCo2 subsequently studied 5,522 people with chronic coronary disease. The primary cardiovascular endpoint occurred in 6.8% with colchicine versus 9.6% with placebo, representing about a 31% relative reduction.
In 2023, the FDA approved colchicine 0.5 mg daily to reduce myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adults with established atherosclerotic disease or multiple cardiovascular risk factors.
Why would an anti-inflammatory drug protect arteries?
Atherosclerosis is not simply cholesterol accumulating inside a pipe. Inflammation participates in the development and complications of atherosclerotic plaque.
Colchicine interferes with several inflammatory processes, including microtubule-dependent immune-cell activity, neutrophil function, and activation of the NLRP3 inflammasome—one of the three inflammatory pathways followed by Long on Meds.
The cardiovascular trials are particularly important because they move the argument beyond inflammatory laboratory markers: patients actually experienced fewer cardiovascular events.
What dose do I take?
The major cardiovascular trials and FDA cardiovascular indication use 0.5 mg once daily.
I take 0.6 mg once daily, the longstanding generic tablet. My reason is practical. In my own wholesale purchasing, 100 generic 0.6 mg tablets cost about $20, while 30 tablets of the 0.5 mg cardiovascular formulation cost more than $500.
Those are my wholesale prices and should not be interpreted as what every patient will pay. The cardiovascular outcome evidence specifically supports the 0.5 mg dose.
Is low-dose colchicine safe enough for long-term use?
Low-dose colchicine has accumulated substantial long-term safety experience in appropriately selected patients.
Diarrhea and gastrointestinal symptoms can occur, although in my own clinical experience using approximately 0.6 mg daily, I do not recall a patient discontinuing treatment because of gastrointestinal side effects.
Colchicine can also cause muscle or nerve toxicity, but serious toxicity at low daily doses is uncommon in appropriately selected patients. Kidney or liver impairment and certain interacting medications can substantially increase colchicine exposure and the risk of toxicity.
That is why colchicine should be reviewed with a physician who knows your kidney function, liver function, and other medications.
My interest in colchicine began with gout and a hypothesis about inflammation. What makes this story unusual is what happened afterward: large randomized trials demonstrated cardiovascular benefit, and low-dose colchicine eventually became an FDA-approved cardiovascular therapy. For me, it is one of the clearest examples of the Long on Meds principle—an old medication finding an important new role in disease avoidance.
Learn more about inflammaging and inflammatory pathways, or use Check a Medication to examine colchicine and other medications.