Background/Purpose: While two trials with colchicine have demonstrated its efficacy in reducing the risk of cardiovascular events, a more recent study showed no significant impact on the composite primary outcome over three years. This study aims to evaluate the cardioprotective effects of colchicine on the incidence of myocardial infarction requiring bypass surgery or stent placement, utilizing a nationwide historical cohort.

Methods: The electronic medical registry system of Turkiye was retrospectively analyzed for the period between January 1, 2015, and December 31, 2024. Individuals aged 50 or older who regularly used colchicine (defined as being prescribed at least 3 times per year) between January 1, 2018, and December 31, 2024, were identified as the study group, which consisted mainly of patients with familial Mediterranean fever (FMF) and gout. A control group, matched 1:1 for age, gender, and history of diabetes mellitus (DM), hypertension, hyperlipidemia, and chronic renal failure, was selected. Additionally, a second set with a case-to-control ratio of 1:2 was prepared, matching participants based on geographical region. Subgroup analyses were conducted on statin users and on a third set with a 1:2 ratio, matched for a history of gout. The primary outcome was defined as the first myocardial infarction (MI) requiring bypass surgery or stent placement. The association of colchicine use with the likelihood of cardiovascular endpoint was investigated through logistic regression models.

Results: A total of 41,971 individuals who regularly used colchicine during the defined period were identified, along with a matched control group of 41,833 individuals. During the study, 5,278 participants were diagnosed with myocardial infarction (MI) requiring bypass surgery or stent placement. Multivariate logistic regression analysis showed a significantly lower rate of cardiovascular events in the colchicine group compared to the control group (OR=0.769, 95% CI: 0.724–0.816, p< 0.001). A similar analysis using a larger, geographically matched control group at a 1:2 ratio yielded comparable results (OR=0.770, 95% CI: 0.731–0.812, p< 0.001). In a subgroup analysis with a control group matched for gout, the protective effect of colchicine persisted, albeit to a lesser extent (OR=0.882, 95% CI: 0.836–0.930, p< 0.001). Interestingly, colchicine’s protective effect was evident in individuals not using statins (OR=0.741, 95% CI: 0.694–0.790, p< 0.001), but no significant difference was observed among regular statin users. Additionally, there was no statistically significant difference in cardiovascular event risk between controls using statins and individuals on colchicine who were not using statins (OR=0.976, 95% CI: 0.860–1.109, p=0.0906).

Conclusion: This nationwide health record study represents the largest cohort of patients and controls to date, reinforcing earlier clinical trial findings by demonstrating a reduction in cardiovascular event rates associated with colchicine use. The relatively lower protective effects observed in gout patients may be linked to higher cardiovascular risks, lower colchicine dosages, and potentially greater non-compliance compared to patients with FMF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nationwide-historical-cohort-study-on-the-primary-prophylactic-effects-of-colchicine-in-cardiovascular-events/