title: Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Colchicine has unique anti-inflammatory properties that may be beneficial in various cardiovascular conditions. This systematic review and meta-analysis of randomized controlled trials (RCTs) examines this issue.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and the Cochrane Database from inception to June 2014 for RCTs using colchicine in adult patients with cardiac diseases. Results were pooled using random effects.
  
  
  RESULTS
  15 RCTs (n = 3431 patients, median treatment 3 and follow-up 15 months) were included. All but 2 used colchicine 1 mg/day. In 5 trials, n = 1301) at risk for cardiovascular disease (coronary artery disease, acute coronary syndrome or stroke, post-angioplasty [2 RCTs], or congestive heart failure), colchicine reduced composite cardiovascular outcomes by ~60 % (risk ratio [RR] 0.44, 95 % confidence interval [CI] 0.28-0.69, p = 0.0004; I(2) = 0 %) and showed a trend towards lower all-cause mortality (RR 0.50, 95 % CI 0.23-1.08, p = 0.08; I(2) = 0 %). In pericarditis or post-cardiotomy, colchicine decreased recurrent pericarditis or post-pericardiotomy syndrome (RR 0.50, 95 % CI 0.41-0.60, p < 0.0001; I(2) = 0 %; 8 RCTs, n = 1635), and post-pericardiotomy or ablation induced atrial fibrillation (RR 0.65, 95 % CI 0.51-0.82, p = 0.0003; I(2) = 31 %; 4 RCTs, n = 1118). The most common adverse event was diarrhea. Treatment discontinuation overall and due to adverse events (RR 4.34, 95 % CI 1.70-11.07, p = 0.002; I(2) = 29 %; 7 RCTs, 83/790 [10.5 %] vs. 11/697 [1.6 %]) was higher in colchicine-assigned patients.
  
  
  CONCLUSIONS
  Current RCT data suggests that colchicine may reduce the composite rate of cardiovascular adverse outcomes in a range of patients with established cardiovascular disease. Furthermore, colchicine reduces rates of recurrent pericarditis, post-pericardiotomy syndrome, and peri-procedural atrial fibrillation following cardiac surgery. Further RCTs evaluating the potential of colchicine for secondary prevention of cardiovascular events would be of interest.
authors: Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. vermasu@smh.ca.|Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. vermasu@smh.ca.|Department of Surgery, University of Toronto, Toronto, ON, Canada. vermasu@smh.ca.
authors: Subodh
authors: S
authors: Verma
authors: Department of Medicine, McMaster University, Hamilton, ON, Canada. eikelbj@mcmaster.ca.
authors: John W
authors: JW
authors: Eikelboom
authors: Heart Research Institute, Perth, WA, Australia. smnidorf@gmail.com.
authors: Stefan M
authors: SM
authors: Nidorf
authors: Division of Vascular Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. alomranm@smh.ca.|Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. alomranm@smh.ca.|Department of Surgery, University of Toronto, Toronto, ON, Canada. alomranm@smh.ca.
authors: Mohammed
authors: M
authors: Al-Omran
authors: Department of Medicine, McMaster University, Hamilton, ON, Canada. nandini.gupta@medportal.ca.
authors: Nandini
authors: N
authors: Gupta
authors: Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.|Division of Endocrinology & Metabolism, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.|Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.|Department of Medicine, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.
authors: Hwee
authors: H
authors: Teoh
authors: Department of Medicine, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. FriedrichJ@smh.ca.|Department of Critical Care, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. FriedrichJ@smh.ca.|Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. FriedrichJ@smh.ca.
authors: Jan O
authors: JO
authors: Friedrich
mesh_terms: D003078:Colchicine / Q000627:therapeutic use*; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
chemical_list: D003078:Colchicine