Effect of colchicine for secondary prevention of cardiovascular diseases in individuals with diabetes: A meta-analysis of randomized trials

AimsColchicine is effective for secondary prevention of major adverse cardiovascular events (MACE), yet its benefit in individuals with diabetes remains uncertain despite their elevated cardiovascular risk. This systematic review and meta-analysis assessed the impact of colchicine on cardiovascular outcomes in individuals with diabetes.MethodsDatabases were searched from inception to November 2024 for randomized controlled trials assessing colchicine for reducing MACE. A meta-analysis was performed using RevMan 5.4 with a fixed-effects inverse-variance model to generate pooled risk ratios (RR, HR). PROSPERO registration: CRD42024575366.ResultsFive RCTs were included, comprising 2977 participants with diabetes (1492 (50%) colchicine; 1485 (50%) placebo/usual care). Most were males over 60 years. Colchicine significantly reduced MACE, HR 0.79 (95% CI 0.67-0.94, p = 0.006). Subgroup analysis of diabetic versus non-diabetic participants yielded a similar effect, HR 0.75 (95% CI 0.67-0.83, p < 0.001). Colchicine did not increase adverse events: composite events RR 0.81 (95% CI 0.68-0.96; <i>p</i> = 0.02), gastrointestinal events RR 1.09 (95% CI 0.98-1.20, p = 0.12), or musculoskeletal events RR 0.77 (95% CI 0.43-1.38, p = 0.39). Benefits were observed with 0.5 mg daily over a median 28.6 months.ConclusionColchicine is associated with a reduction in major cardiovascular events in individuals with diabetes, with consistent long-term benefit at low doses without an increase in adverse effects.