Low-Dose Colchicine May Help Stabilize Coronary Plaques

The LoDoCo2 trial found a reduced cardiovascular risk with low-dose colchicine in patients with chronic coronary disease. In this substudy, attenuation of pericoronary adipose tissue did not differ between patients receiving low-dose colchicine and those receiving placebo; however, people taking colchicine had a higher volume of dense calcified plaque, indicating improved plaque stability.
METHODOLOGY:
Elevated attenuation of pericoronary adipose tissue and a high burden of noncalcified plaque have been linked to adverse coronary outcomes caused by plaque rupture and instability; statins mitigate these risks by promoting plaque calcification.
This cross-sectional substudy of the LoDoCo2 trial investigated if treatment with low-dose colchicine would attenuate coronary inflammation, as evidenced by less attenuation of pericoronary adipose tissue in 151 patients with chronic coronary disease (mean age, 64.4 years; 14% women).
Patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily; n = 79) or placebo (n = 72).
All patients had previously undergone coronary stenting at enrollment and were on antiplatelet and/or anticoagulant therapy; high-intensity statin therapy consisted of 40 mg and 80 mg doses of atorvastatin.
After a median treatment duration of 28 months, coronary CT angiography (CCTA) was performed to evaluate the attenuation of pericoronary adipose tissue in the proximal segments of epicardial coronary arteries and to assess plaque characteristics.
TAKEAWAY:
Median attenuation did not differ significantly between the patients receiving colchicine and those receiving placebo.
Compared with patients receiving placebo, those receiving colchicine showed a higher calcified plaque burden (adjusted difference, 2.4%), higher calcified plaque volume (adjusted difference, 59 mm 3 ), and higher volume of dense calcified plaque (adjusted difference, 61.5 mm 3 ; P < .05 for all).
), and higher volume of dense calcified plaque (adjusted difference, 61.5 mm ; < .05 for all). In patients on low-intensity statin therapy, colchicine treatment was associated with a lower burden of low-attenuation plaque, an effect not observed in those receiving high-intensity statins ( P for interaction = .037).
IN PRACTICE:
Low-dose colchicine was associated with an overall higher volume of calcified plaque, particularly dense calcified plaque, as well as a lower burden of low-attenuation plaque in participants treated
with colchicine and low-intensity statins,' the researchers wrote. 'Although the cross-sectional design of the study limits causal inference, these are features of plaque stability and may partly explain the reduction in risk of cardiovascular events associated with colchicine in patients with chronic coronary disease.'
SOURCE:
This study was led by Aernoud T L Fiolet, MD, PhD, of University Medical Centre Utrecht, Utrecht, the Netherlands. It was published online on May 19, 2025, in Heart .
LIMITATIONS:
The researchers conducted this cross-sectional analysis at the end of treatment, without any baseline or temporal studies. This study had relatively fewer women than the proportion of women with cardiovascular disease in the general population. Additional imaging modalities were not used to confirm the findings from CCTA.
DISCLOSURES:
This study received grants from the Australian National Institutes of Health/National Heart, Lung, and Blood Institute, Withering Stichting Nederland, the Netherlands Heart Foundation, and the Netherlands Organisation for Health Research and Development. One author reported receiving software royalties from Cedars-Sinai Medical Center. Another author reported giving presentations, and three authors reported serving as consultants for pharmaceutical and healthcare companies without receiving any personal fees.

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