A Systematic Review on the Effect of Colchicine in Cardiovascular Disease Management: From Risk Reduction to Comprehensive Care

Inflammation plays an essential role in the pathogenesis of cardiovascular diseases (CVDs), and despite advances in treatments, challenges still exist. Recent studies have explored the use of colchicine in reducing the risk of CVDs. Therefore, the present systematic review aimed to evaluate the impact of colchicine in terms of efficacy, safety, and therapeutic role in managing CVD patients. A comprehensive literature search was performed from different electronic databases, such as PubMed, Scopus, and the Cochrane Library, using keywords associated with the aim of the study, using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Methodological quality assessment was performed using the Cochrane risk of bias-2.0 (RoB-2.0) and the Risk of Bias in Non-Randomized Studies-Intervention (ROBINS-I) tools for randomized controlled trials (RCTs) and non-RCTs, respectively. For the meta-analysis, RevMan 5.4 was used to construct forest plots. Finally, 19 studies were included for qualitative and quantitative analyses. Both male and female patients were included in the studies; however, studies were more skewed toward male patients reported with different types of CVDs, including acute pericarditis, coronary artery disease (CAD), heart failure, and myocardial infarction, and also reported comorbidities, like hypertension (HTN), diabetes, and dyslipidemia. Overall, a low dose of 0.5 mg/daily of colchicine was used. A high adherence rate (>85%) was observed in the studies, with few cases of discontinuation of medications. Numerous studies have reported that colchicine successfully benefits in reducing the inflammatory and other biomarkers, such as C-reactive protein (CRP), Interleukin (IL)-6, and IL-1β. The pooled estimate size for comorbidities, like diabetes, was 0.94, odds ratio (OR) (95% CI, 0.86-1.02, p = 0.13, I²= 0%). For hypertension and dyslipidemia, it was 1, OR (95% CI, 0.93-1.07, p = 0.95, I² = 9%) and 0.89, OR (95% CI, 0.66-1.2, p = 0.46, I² = 0%), respectively. Meanwhile, the overall effect size was 0.97, OR (95% CI, 0.92-1.02, p = 0.29, I² = 0%). The pooled estimate size for major adverse cardiovascular events (MACEs) and all complications was 0.68, OR (95% CI, 0.36-1.26, p = 0.22, I² = 47%) and 1.60, OR (95% CI, 1.11-2.31, p = 0.01, I²= 65%). The overall effect size was 1.26, OR (95% CI, 0.92-1.72, p = 0.16, I² = 63%). Furthermore, the pooled estimate size for mortality associated with CVDs and all-cause mortality was 0.77, OR (95% CI, 0.56-1.06, p = 0.11, I²= 17%) and 1.11, OR (95% CI, 0.72-1.71, p = 0.65, I² = 48%), with the overall effect size of 0.89, OR (95% CI, 0.70-1.12, p = 0.32, I²= 40%). These outcomes suggest that colchicine offers potential anti-inflammatory benefits in CVD patients, but its clinical impact on outcomes, like MACE and mortality, remains uncertain due to the non-significant difference, warranting further large-scale, high-quality multicenter studies.