Colchicine use and cardiovascular event risk in Chinese adults starting urate-lowering therapy: a cohort study

Low-dose colchicine may reduce recurrent cardiovascular events in secondary prevention, but its real-world effectiveness in primary prevention remains uncertain. To examine the association between colchicine use and cardiovascular disease (CVD) risk among Chinese adults initiating urate‑lowering therapy. Using the Beijing Medical Claim Data for Employees (2008–2017), we identified adults without prior CVD who initiated urate-lowering therapy. Colchicine exposure was defined as ≥ 1 dispensing within 30 days of initiation. Propensity score fine stratification weighting was used to balance baseline characteristics. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD and its components, including ischemic heart disease, heart failure, and cerebrovascular disease, with stroke and all-cause mortality as secondary outcomes. After weighting, the study included 6,157 colchicine users and 279,309 non-users initiating urate-lowering therapy (median follow up of 3.05 years). Colchicine was not associated with incident CVD (weighted incidence 1.62 vs. 1.59 per 100 person-years; HR, 1.01; 95% CI, 0.91 to 1.12). No associations were observed for ischemic heart disease (HR, 1.01; 95% CI, 0.88 to 1.16), heart failure (HR, 1.17; 95% CI, 0.83 to 1.66), cerebrovascular disease (HR, 0.94; 95% CI, 0.79 to 1.12), and stroke (HR, 0.96; 95% CI, 0.79 to 1.17). All-cause mortality was lower among colchicine users (HR, 0.74; 95% CI, 0.64 to 0.86). In this large real-world Chinese cohort initiating urate-lowering therapy, colchicine use was not associated with CVD risk. These findings do not support routine colchicine use for primary cardiovascular prevention at urate-lowering therapy initiation.