Animati FM, Cappannoli L, Proietti S, Fracassi F, Montone RA, Ierardi C, Aurigemma C, Romagnoli E, Paraggio L, Lunardi M, Bianchini F, Leone AM, Trani C, Liuzzo G, Burzotta F. Colchicine in coronary artery and cerebrovascular disease: “Old skin for the new ceremony”. World J Cardiol 2025; 17(11): 110563 [DOI: 10.4330/wjc.v17.i11.110563]
Corresponding Author of This Article
Luigi Cappannoli, MD, PhD, Consultant, Postdoctoral Fellow, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome 00168, Lazio, Italy. luigi.cappannoli@guest.policlinicogemelli.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Nov 26, 2025; 17(11): 110563 Published online Nov 26, 2025. doi: 10.4330/wjc.v17.i11.110563
Colchicine in coronary artery and cerebrovascular disease: “Old skin for the new ceremony”
Francesco M Animati, Luigi Cappannoli, Simone Proietti, Francesco Fracassi, Rocco A Montone, Carolina Ierardi, Cristina Aurigemma, Enrico Romagnoli, Lazzaro Paraggio, Mattia Lunardi, Francesco Bianchini, Antonio Maria Leone, Carlo Trani, Giovanna Liuzzo, Francesco Burzotta
Francesco M Animati, Luigi Cappannoli, Simone Proietti, Francesco Fracassi, Rocco A Montone, Carolina Ierardi, Cristina Aurigemma, Enrico Romagnoli, Lazzaro Paraggio, Mattia Lunardi, Francesco Bianchini, Carlo Trani, Giovanna Liuzzo, Francesco Burzotta, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Lazio, Italy
Antonio Maria Leone, Department of Diagnostic and Interventional Cardiology, Center of Excellence in Cardiovascular Science, Ospedale Isola Tiberina-Gemelli Isola, Rome 00186, Lazio, Italy
Co-first authors: Francesco M Animati and Luigi Cappannoli.
Author contributions: Proietti S and Fracassi F participated in manuscript writing and review; Montone RA, Ierardi C, Aurigemma C, Romagnoli E, Paraggio L, Lunardi M, Bianchini F, Leone AM, Trani C, Liuzzo G and Burzotta F contributed to the review and supervision of this manuscript. All authors have read and approved the final manuscript. Animati FM and Cappannoli L are co-first authors because they contributed equally and substantially to the intellectual development of the manuscript. Their contributions encompass article conception and design, data acquisition and analysis, and the drafting and critical revision of the final text.
Conflict-of-interest statement: Burzotta F received speaker's fees from Abbott, Abiomed, Edwards, Medtronic, Terumo, outside the present work. Cappannoli L received a fellowship grant from Abiomed, outside the present work. The remaining authors declare that they have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luigi Cappannoli, MD, PhD, Consultant, Postdoctoral Fellow, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, Rome 00168, Lazio, Italy. luigi.cappannoli@guest.policlinicogemelli.it
Received: June 13, 2025 Revised: July 7, 2025 Accepted: October 11, 2025 Published online: November 26, 2025 Processing time: 165 Days and 8.4 Hours
Abstract
Colchicine is one of the most widely used drugs in the world. While it is most commonly used in the treatment and prevention of gout, it is also widely used to treat other chronic inflammatory diseases, such as familial Mediterranean fever and Behçet’s disease. Regarding cardiovascular disease, an established use of colchicine concerns pericarditis, both acute and chronic, and its effectiveness in this context is supported by multiple studies and robust evidence. Regarding coronary artery disease (CAD), colchicine use has been endorsed in both acute and chronic coronary syndromes (CCS), primarily because of two randomized controlled trials: The COLCOT trial for patients with acute coronary syndromes (ACS) and the LoDoCo2 trial for patients with CCS. Considering this robust evidence, CCS 2024 European Society of Cardiology (ESC) Guidelines recommended 0.5 mg daily colchicine in patients with atherosclerotic CAD to reduce the risk of myocardial infarction, stroke and need for revascularization. However, a few months after the publication of 2024 ESC Guidelines on CCS, the “CLEAR” trial demonstrated that among patients who had experienced an acute myocardial infarction, when initiated shortly after the event and continued for a median of 3 years, colchicine did not reduce the incidence of the composite outcome of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization. This result casts doubt on the indication for colchicine use in ACS and weakens evidence that had previously led to the routine use of colchicine in clinical cardiology practice. This review aims to shed light on the current and past scientific evidence underlying the use of colchicine in ACS, CCS and cerebrovascular disease, and thus seeks to provide a quick yet effective tool for cardiologists facing the long-standing issue of reducing residual inflammatory risk in patients with coronary atherosclerotic disease.
Core Tip: This review aims to provide a practical, up-to-date resource on the utility of colchicine in atherosclerotic disease and is intended for cardiologists who confront the daily challenge of mitigating systemic inflammation in cardiovascular patients. Current guidelines support its use to reduce recurrent cardiovascular events, yet recent findings have questioned its benefit in acute settings. This highlights the need for clinicians to balance established recommendations with emerging evidence when considering colchicine as part of long-term cardiovascular risk management.
