What is colchicine and why are cardiologists prescribing it for inflammation?

Colchicine in low-dose form (0.5 mg daily, marketed as Lodoco) received FDA approval in 2023 for cardiovascular risk reduction in patients with established atherosclerotic cardiovascular disease. It is not a supplement, it is a drug with a century of use in gout and pericarditis that was repurposed after the LoDoCo2 trial (NEJM, 2020) demonstrated a 31% reduction in major adverse cardiovascular events in patients with stable coronary artery disease.

The mechanism is specific: colchicine inhibits the NLRP3 inflammasome, the intracellular machinery that activates macrophage-driven plaque inflammation. This pathway is distinct from the LDL-lowering mechanism of statins and from the general anti-inflammatory effects of omega-3 fatty acids. Colchicine targets the specific inflammatory process within plaques that causes them to rupture, the event that produces most heart attacks. For men with established CAD whose hs-CRP remains elevated despite statin therapy and lifestyle modification, low-dose colchicine is now a legitimate second-line pharmacological option with outcome data behind it. (Nidorf et al., NEJM, 2020)

Cardiologist's calibrated position, Solid (1) for colchicine in stable CAD (the LoDoCo2 trial population). Early (3) for primary prevention in men without established CVD.

What to do: If you have established coronary artery disease (prior MI, stent, CABG, or known CAC above 400) and your hs-CRP remains above 2.0 mg/L on right statin therapy, ask your cardiologist specifically about low-dose colchicine.

For the full picture, read Inflammation's Invoice.