Aernoud Fiolet

75 Colchicine in Stable Coronary Artery Disease INTRODUCTION A therosclerosis is a slowly progressive disease. Ischemic heart disease is responsible for >15% of all global deaths, being among the top 3 most important noncommunicable diseases in almost every developed country. 1,2,3 Management of atherosclerosis has improved significantly during the last 50 years. Controlling lifestyle, dyslipidemia, and thrombosis has reduced associated mortality rates in the last 2 decades by 25%–50%. 1, 4,5 However, even with these treatment strategies, any given individual with stable coronary artery disease may have a 5-year risk of at least 15% for cardiovascular death or any major adverse cardiovascular event. 6,7,8,9,10 This residual risk reflects a mechanism in the biology of atherothrombosis that is incompletely addressed by lipid lowering and antithrombotic therapy, which is modulation of the inflammatory response that drives the atherosclerotic process. 11 The ability of novel anti-inflammatory drugs to modify this inflammatory response has been the subject of recent research, yielding varying effects. The decades-old drug colchicine, however, has also emerged with promising results in stable coronary artery disease. Colchicine is an inexpensive drug that is readily available throughout the world, with proven safety and efficacy for several inflammatory diseases. The goal of the present review was to provide an overview of the mechanism of action of colchicine in stable coronary disease and a summary of the clinical evidence regarding its efficacy and safety. MATERIALS AND METHODS To summarize the body of available evidence, a scoping review design was used to incorporate a range of studies and report in a narrative format. For this purpose, we identified literature by performing a search in the bibliographic databases of MEDLINE (PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials using “colchicine” AND “cardiovascular disease” OR “colchicine” AND “coronary artery disease” and synonyms as search terms. We also used similar search terms investigating the United States National Library of Medicine clinical trial database (http://www.clinicaltrials.gov ) and the Australian and New Zealand Clinical Trials Registry ( http://www.anzctr.org.au ). Cross-references were checked for all articles. No language or publication restrictions were used. Although broad search terms were used, the focus was on research conducted on colchicine in atherosclerosis models or clinical research on stable coronary disease.