Colchicine in Cardiovascular Disease: In-Depth Review

Spyridon G. Deftereos, MD, PhD; Frans J. Beerkens, MD; Binita Shah, MD, MS; George Giannopoulos, MD, PhD; Dimitrios A. Vrachatis, MD, MS, PhD; Sotiria G. Giotaki, MD; Gerasimos Siasos, MD, MS, PhD; Johny Nicolas, MD; Clare Arnott, MBBS, PhD; Sanjay Patel, MBBS, PhD; Mark Parsons, MD, PhD; Jean-Claude Tardif, MD; Jason C. Kovacic, MD, PhD; George D. Dangas, MD, PhD

Disclosures

Circulation. 2022;145(1):61-78.

Abstract and Introduction

Abstract

Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease.

Introduction

Colchicine has carried many names and been used for centuries.^[1,2] The botanical alkaloid compound is derived from the flower Colchicum autumnale, a medicinal plant described as early as 1550 BC in the Egyptian Ebers Papyrus used to treat pain and swelling. The plant and therapeutic lend their names to the ancient Colchis (home to mythological sorceresses Medea and Circe), roughly corresponding to the current republic of Georgia. Through the years, colchicine has been frequently described both for its medicinal use in gout (as early as 129–200 CE) as well as its poisonous effects at high doses. Having survived years of scrutiny, colchicine use is rapidly expanding as it is currently considered for a variety of inflammatory conditions. It carries Food and Drug Administration–approved indications for prevention and treatment of gout flares, as well as treatment of familial Mediterranean fever (FMF). It is also used off label for other inflammatory conditions including pericarditis, calcium pyrophosphate disease, and Adamantiades-Behcet's syndrome.^[3–6] Over the years, many studies have shown that inflammation may significantly contribute to a wider variety of pathologies than traditionally thought, including cardiovascular diseases such as atherosclerosis and atrial fibrillation (AF). Therefore, anti-inflammatory strategies are now being carefully examined for potential broader application across a range of cardiovascular diseases. Given wide availability, low cost, and a rather favorable side-effect (tolerability) profile, colchicine has emerged as a potentially useful oral cardiovascular treatment targeting the inflammatory axis. We will review the role inflammation plays in cardiovascular disease, including various anti-inflammatory strategies, and then examine past and current evidence about colchicine in cardiovascular disease.

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Table 1. Dosing and Duration for Colchicine Stratified by Indication
Clinical Indication	Dose*	Duration
Pericardial disease
Acute and recurrent pericarditis	≥70 kg: 0.5 mg twice daily† <70 kg: 0.5 mg once daily†	3 mo
Dressler's syndrome		3 mo
Postpericardiotomy syndrome		1 mo after cardiacsurgery
Atrial fibrillation
Postoperative atrial fibrillation	0.5 mg once or twice daily	1–3 mo
Postablation atrial fibrillation	0.5 mg once or twice daily	1–3 mo
Coronary artery disease
Stable coronary artery disease	0.5 mg daily	Possibly indefinite
Acute coronary syndrome	0.5 mg daily	Possibly indefinite

*In the United States, 0.6-mg tablets are available, whereas 0.5-mg tablets are used in other countries.
†First day loading dose of 1–2 mg optional but not required.

Table 2. Summary of Key Studies Investigating Colchicine as Adjunct in Inflammatory Pericardial Disease
Study	Design	Population	Intervention	Control	Primary outcome	Colchicine effect	Notable adverse events*
Acute pericarditis
Colchicine in addition to conventional therapy for acute pericarditis: results of the Colchicine for acute Pericarditis (COPE) Imazio et al, 2005³⁰	Prospective, randomized, open-label	Acute pericarditis (n=120)	Colchicine 1.0–2.0 mg for the first day and then 0.5–1.0 mg/d for 3 mo	Conventional treatment	Recurrence rate at 18 mo	10.7% vs 32.3%; P=0.004	Gastrointestinal intolerance (8.3%)
A randomized trial of colchicines for acute pericarditis (ICAP) Imazio et al, 2013³¹	Prospective, randomized, double-blind, placebo-controlled	Acute pericarditis (n=240)	Colchicine 0.5 mg BID for 3 mo for patients weighing >70 kg; 0.5 mg QD for patients weighing ≤70 kg	Placebo	Incessant or recurrent pericarditis at 18 mo	16.7% vs 37.5%; P<0.001; RRR, 0.56 (95% CI, 0.30–0.72)	None
Colchicine administered in the first episode of acute idiopathic pericarditis: a randomized multicenter open-label study Sambola et al, 2019³²	Prospective, randomized, open-label	Acute pericarditis (n=110)	Colchicine 1 mg BID for 3 mo for patients weighing >70 kg; 0.5 mg BID for patients weighing ≤70 kg	Conventional treatment	Recurrence rate at 24 mo	10.9% vs 13.5%; P=0.34; HR, 1.53 (95% CI, 0.7–3.4)	Gastrointestinal intolerance (13.5%)
Recurrent pericarditis
Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (Colchicine for Recurrent pericarditis) trial Imazio et al, 2005³³	Prospective, randomized, open-label	Recurrent pericarditis (n=83)	Colchicine 1.0–2.0 mg the first day and then 0.5–1.0 mg QD for 6 mo	Conventional treatment	Recurrence rate at 20 mo	24.0% vs 50.6%; P=0.02;	Gastrointestinal intolerance (7%)
Colchicine for recurrent pericarditis (CORP): a randomized trial Imazio et al, 2011³⁴	Prospective, randomized, double-blind, placebo-controlled	Recurrent pericarditis (n=120)	Colchicine 1.0–2.0 mg on the first day followed by a maintenance dose of 0.5–1.0 mg QD for 6 mo	Conventional treatment	Recurrence rate at 18 mo	24% vs 55%; P<0.001; ARR, 0.31 (95% CI, 0.13–0.46); RRR, 0.56 (95% CI, 0.27–0.73)	Gastrointestinal intolerance (7%)
Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicenter, double-blind, placebo- controlled, randomized trial Imazio et al, 2014³⁵	Prospective, randomized, double-blind, placebo-controlled	Recurrent pericarditis (n=240)	Colchicine 0.5 mg BID for 6 mo for patients weighing >70 kg or 0.5 mg QD for patients weighing ≤70 kg	Conventional treatment	Recurrence rate at 18 mo	21.6% vs 42.5%; P=0.0009; RR, 0.49 (95% CI, 0.24–0.65)	Gastrointestinal intolerance (7.5%) Hepatotoxicity (2.5%)
Postpericardiotomy syndrome
Colchicine for the prevention of postpericardiotomy syndrome Finkelstein et al, 2002³⁶	Prospective, randomized, double-blind, placebo-controlled	Cardiac surgery (n=163)	POD 3: colchicine 1.5 mg QD for 1 mo	Placebo	PPS at 3 mo	10.6% vs 21.9%; P<0.135	Not reported
Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicenter, randomized, double-blind, placebo-controlled trial Imazio et al, 2010³⁷	Prospective, randomized, double-blind, placebo-controlled	Cardiac surgery (n=336)	POD 3: colchicine 1 mg BID for 1 d, followed by 0.5 mg BID until 1 mo (dose reduced for ≤70 kg)	Placebo	PPS at 12 mo	8.9% vs 21.1%; P=0.002; RRR, 0.579 (95% CI, 0.273–0.756)	Gastrointestinal intolerance (8.9%)
Colchicine for prevention of post-pericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial Imazio et al, 2014³⁸	Prospective, randomized, double-blind, placebo-controlled	Cardiac surgery (n=360)	Colchicine 0.5 mg BID (0.5 mg daily if <70 kg), 48–72 h preoperatively until 1 mo postoperatively	Placebo	PPS at 3 mo	19.4% vs 29.4%; absolute difference, 10.0% (95% CI, 1.1%–8.7%)	Gastrointestinal intolerance (14.4%)

ARR indicates absolute risk reduction; HR, hazard ratio; POD, postoperative day; PPS, postpericardiotomy syndrome; RR, relative risk; and RRR, relative risk reduction.
*Notable adverse events include events significantly increased compared with the control group. If no comparison was made, events were included that were deemed of interest.

Table 3. Summary of Key Studies Investigating Colchicine as Adjunct in Postprocedural Atrial Fibrillation
Study	Design	Population	Intervention	Control	Primary outcome	Colchicine effect	Notable adverse events*
Postoperative atrial fibrillation
Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy Imazio et al, 2011⁴⁵	Prospective, randomized, double-blind, placebo-controlled	Any cardiac surgery (n=336)	Colchicine 1 mg BID on day 3 postoperatively, followedby 0.5 mg BID for 1 mo (dose reduced for </=70 kg)	Placebo	Postoperative AF at 1 mo	12.0% vs 22.0%, P=0.021; RRR, 0.45 (95% CI, 0.34–0.94)	Gastrointestinal intolerance (9.5%)
Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial Imazio et al, 2014⁴⁰	Prospective, randomized, double-blind, placebo-controlled	Any cardiac surgery (n=360)	Colchicine 0.5 mg BID (0.5 mg daily if <70 kg) 48–72 h before surgery, then 1 mo postoperatively	Placebo	PPS (secondary outcome, postoperative AF) at 3 mo	33.9% vs 41.7%; absolute difference, 7.8% (95% CI, −2.2% to 17.6%)	Gastrointestinal intolerance (14.4%)
Low dose colchicine in prevention of atrial fibrillation after coronary artery bypass graft: a double blind clinical trial Sarzaeem et al, 2014⁴⁶	Prospective, randomized, blinded, placebo-controlled	Coronary artery bypass surgery (n=216)	Colchicine 1 mg BID 2 doses before surgery, then 0.5 mg BID for 5 d	Placebo	Postoperative AF at 6 mo	14.8% vs 30.6%; P=0.006	Not reported
Colchicine to reduce atrial fibrillation in the postoperative period of myocardial revascularization Zarpelon et al, 2016⁴⁷	Prospective, randomized, open-label	Elective coronary artery bypass surgery (n=140)	Colchicine 1 mg BID preoperatively, then 0.5 mg BID until hospital discharge	No colchicines therapy	Postoperative AF at hospital discharge	7.04% vs 13.04%; P=0.271; RRR, 0.46 (95% CI, −0.53 to 0.81)	Not reported
Effect of colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF Trial Tabbalat et al, 2020⁴⁸	Prospective, randomized, open-label, placebo-controlled	Elective cardiac surgery (n=152)	Colchicine 1 mg once 12–24 h preoperatively, followed by 0.5 mg QD until hospital discharge	Placebo 12–24 h preoperatively, followed by placebo until hospital discharge	Postoperative AF at hospital discharge	16% vs 18.3%; P=0.88; OR, 0.85 (95% CI, 0.37–1.99)	Gastrointestinal intolerance (2.4%)
Postpulmonary vein isolation atrial fibrillation
Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study Deftereos et al, 2012⁴⁹	Prospective, randomized, double-blind, placebo-controlled	Pulmonary vein isolation (n=161)	Colchicine 0.5 mg BID from day 1 after procedure for 3 mo	Placebo	Postprocedure AF at 3 mo	16% vs 33.5%; P=0.01; OR, 0.38 (95% CI, 0.18–0.80)	Gastrointestinal intolerance (8.6%)
Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: Mid-term efficacy and effect on quality of life Deftereos et al, 2014⁵⁰	Prospective, randomized, double-blind, placebo-controlled	Pulmonary vein isolation (n=223)	Colchicine 0.5 mg BID from day 1 after procedure for 3 mo	Placebo	Postprocedure AF at 15 mo	31.1% vs 49.5%; P=0.01; RRR, 0.37; OR, 0.46 (95% CI, 0.26–0.81)	Gastrointestinal intolerance (9.7%)

AF indicates atrial fibrillation; OR, odds ratio; PPS, postpericardiotomy syndrome; and RRR, relative risk reduction.
*Notable adverse events include events significantly increased compared with the control group. If no comparison was made, events were included that were deemed of interest.

Table 4. Summary of Key Studies Investigating Colchicine as Adjunct in Atherosclerosis Including Acute Coronary Syndrome and Stable Coronary Artery Disease
Study	Design	Population	Intervention	Control	Primary outcome	Colchicine effect	Notable adverse events*
Stable coronary artery disease
Low-dose colchicine for secondary prevention of cardiovascular disease (LoDoCo trial) Nidorf et al, 2013⁷³	Prospective, randomized, observer-blinded, open-label	Stable CAD (n=532)	Colchicine 0.5 mg QD until study completion	Conventional treatment	Composite of ACS, out-of-hospital cardiac arrest, or noncardioembolic ischemic stroke at median follow-up of 3 y	5.3% vs 16%; P<0.001; HR, 0.33 (95% CI, 0.18–0.59)	Gastrointestinal intolerance (2.5%) Myalgia (0.9%) Myositis (1 case)
Colchicine in patients with chronic coronary disease (LoDoCo2 trial) Nidorf et al, 2020⁷⁴	Prospective, randomized, double-blind, placebo-controlled	Stable CAD (n=5522)	Colchicine 0.5 mg QD until study completion	Placebo	Composite of CV death, spontaneous (nonprocedural) MI, ischemic stroke, or ischemia-driven coronary revascularization at median follow-up of 28.6 mo	6.8% vs 9.6%; P<0.001; HR, 0.69 (95% CI, 0.57–0.83)	Noncardiovascular death (1.9%; HR, 1.51 [95% CI, 0.99–2.31]) Myalgia‡ (21.2%; cumulative incidence ratio, 1.15 [95% CI, 1.01–1.31]) Gastrointestinal intolerance (15.4% during run-in period)
Acute coronary syndrome
Colchicine in patients with acute coronary syndrome: the Australian COPS randomized clinical trial Tong et al, 2020⁷⁵	Prospective, randomized, doubleblind, placebo-controlled	Patients hospitalized with ACS (n=795)	Colchicine 0.5 mg BID for the first month, then 0.5 mg QD for 11 mo	Placebo	Composite of all-cause mortality, ACS, ischemia-driven (unplanned) urgent revascularization, and noncardioembolic ischemic stroke at 12 mo†	6.1% vs 9.5%; P=0.09; HR, 0.65 (95% CI, 0.38–1.09)	Total death (8 vs 1; P=0.017) Noncardiovascular death (5 vs 0; P=0.024)
Effect of Colchicine on Myocardial Injury in Acute Myocardial Infarction Mewton et al, 2021⁷⁶	Phase 2, prospective, randomized, double-blind, placebo-controlled	ACS (n=194)	Colchicine 2 mg bolus followed by colchicines 0.5 mg BID for 5 d	Placebo	Infarct size by CMR at 5 d	mean of 26 g (IQR 16–44) vs 28.4 g (IQR 14–40); P=0.87	LV thrombus (22.2% vs 7.4%; P=0.01) Gastrointestinal intolerance (34.4% vs 10.1%; P=0.0001)
After myocardial infarction
Efficacy and safety of low-dose colchicine after myocardial infarction (COLCOT trial), Tardif et al, 2019⁷⁷	Prospective, randomized, double-blind, placebo-controlled	Acute MI within 30 days (n=4745)	Colchicine 0.5 mg QD until study completion	Placebo	Composite of death from CV causes, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization at median follow-up of 22.6 mo	5.5% vs 7.1%; P=0.02; HR, 0.77 (95% CI, 0.61–0.96)	Pneumonia (0.9% vs 0.4%; P=0.03)

ACS indicates acute coronary syndrome; CAD, coronary artery disease; CMR, cardiac magnetic resonance imaging; CV, cardiovascular; HR, hazard ratio; IQR, interquartile range; LV, left ventricular; and MI, myocardial infarction.
*Notable adverse events include events significantly increased compared with the control group. If no comparison was made, events were included that were deemed of interest.
†Longer follow-up results still awaited.
‡Only reported among the cohort from The Netherlands.

Table 5. Summary of Key Studies Investigating Colchicine as Adjunct in Percutaneous Coronary Interventions
Study	Design	Population	Intervention	Control	Primary outcome	Colchicine effect	Notable adverse events*
Percutaneous coronary intervention
Ineffectiveness of colchicine for the prevention of restenosis after coronary angioplasty O'Keefe et al, 1992⁸⁹	Prospective, randomized, double-blind, placebo-controlled	PTCA (n=130)	Colchicine 0.6 mg BID until study completion	Placebo	Restenosis at 6 mo	46% vs 45%; P value nonsignificant	Gastrointestinal intolerance (28%)
Combination of lovastatin, enalapril, and colchicine does not prevent restenosis after percutaneous transluminal coronary angioplasty Freed et al, 1995⁹⁰	Prospective, open-label	PTCA (n=50)	Colchicine 0.6 mg BID + lovastatin 20 mg QD + enalapil 2.5–10 mg BID (titrated to SBP >100 mm Hg) + aspirin 81 mg QD until study completion	N/A	Late loss in lumen diameter at 16 wk	0.5 mm±0.8 mm†	Gastrointestinal intolerance (18%)
Colchicine treatment for the prevention of bare-metal stent restenosis in diabetic patients Deftereos et al, 2013⁸⁵	Prospective, randomized, double-blind, placebo-controlled	BMS PCI in patients with diabetes (n=196)	Colchicine 0.5 mg BID until study completion	Placebo	Angio- and IVUS-ISR at 6 mo	Angio-ISR: 16% vs 33%; P=0.007; OR, 0.38 (95% CI, 0.18–0.79); IVUS-ISR: 24% vs 43%; P=0.006; OR, 0.42 (95% CI, 0.22–0.81)	Gastrointestinal intolerance (16% vs 7%; P=0.058)
Effects of acute colchicine administration prior to percutaneous coronary intervention: COLCHI-CINE-PCI randomized trial Shah et al, 2020⁹¹	Prospective, randomized, double-blind, placebo-controlled	ACS or stable CAD PCI (n=400)	Colchicine 1.2 mg once before PCI, and 0.6 mg once after PCI	Placebo at matching time points	PCI-related myocardial injury at 6–8 h and 22–24 h after PCI	57.3% vs 64.2%; P=0.19	Gastrointestinal intolerance (9.3% vs 3.2%; P=0.001)
Colchicine to prevent periprocedural myocardial injury in percutaneous coronary intervention: the COPE-PCI pilot trial Cole et al, 2021⁹²	Prospective, randomized, double-blind, placebo-controlled	NSTEMI or stable angina (n=75)	Colchicine 1 mg followed by 0.5 mg 1 h later, 6–24 h before procedure	Placebo at matching time points	Periprocedural MI; Secondary outcomes include major and minor periprocedural myocardial injury at 24 h after PCI	No periprocedural MI occured in either group Minor: 58% vs 85%; P=0.01 No periprocedural MI occured in either group Major: 31% vs 54%; P=0.04	None

ACS indicates acute coronary syndrome; BMS, bare metal stent; CAD, coronary artery disease; ISR, in-stent restenosis; IVUS, intravascular ultrasound; NSTEMI, non–ST-segment–elevation myocardial infarction; OR, odds ratio; PCI, percutaneous coronary intervention; and PTCA, percutaneous coronary angioplasty.
*Notable adverse events include events significantly increased compared with the control group. If no comparison was made, events were included that were deemed of interest.
†Indicating no prevention of restenosis.

Table 6. Ongoing Major Registered Randomized Clinical Trials With Colchicine in Cardiovascular Disease
Study	Design	Target population	Intervention	Primary outcome	Planned follow-up	Country
Atrial fibrillation
Colchicine for the Prevention of Perioperative Atrial Fibrillation in Patients Undergoing Thoracic Surgery (COP-AF) NCT03310125	Phase 3, prospective, randomized, double-blind	Major thoracic surgery patients (n=2800)	Colchicine 0.5 mg BID for 10 d	POAF	14 d	Canada
Colchicine in Cardiac Surgery (COCS) NCT04224545	Phase 4, prospective, randomized, double-blind	Patients with CABG or AVR (n=1000)	Colchicine 1 mg QD a day before surgery, and 2, 3, 4, and 5 d after surgery	POAF	7 d	Russia
Impact of Short-Course Colchicine Versus Placebo After Pulmonary Vein Isolation (IMPROVE-PVI Pilot) NCT04160117	Phase 3, prospective, randomized, double-blind	RFA PVI (n=200)	Colchicine 0.6 mg BID for 10 d	AF recurrence	2 y	Canada
Coronary artery disease
Colchicine and Spironolactone in Patients With MI/SYNERGY Stent Registry (CLEAR SYNERGY) NCT03048825	Phase 3, prospective, randomized, blinded, doubledummy 2 × 2 factorial design	STEMI or NSTEMI status after PCI (n=7000)	Drug 1: colchicine 0.5 mg BID Drug 2: spironolactone 25 mg QD Device: SYNERGY Bioabsorbable Polymer Drug-Eluting Stent	MACE	1 y	New York, USA
Colchicine Effects on Cardiovascular Outcomes in Acute Coronary Syndrome Study (COLCARDIOACS) ACTRN12616000400460	Prospective, randomized, doubleblind, placebo-controlled	ACS + hs-CRP >2 mg/L 4–6 wk after event (n=3000)	Colchicine 0.5 mg QD for 3 y	Cardiac events	3 y	Australia
Effect of Colchicine in Patients With Myocardial Infarction NCT04218786	Phase 2, prospective, randomized, double-blind	ACS (n=800)	Colchicine 0.5 mg QD for 3 mo	MACE	3 mo	Pakistan
PCI
Oral Colchicine in Argentina to Prevent Restenosis (ORCA) NCT04382443	Phase 4, prospective, randomized, open-label	PCI (n=450)	Arm 1: colchicine 0.5 mg BID for 3 mo + BM Arm 2: DES	MACE	1 y	Argentina
Cerebrovascular disease
Colchicine for Prevention of Vascular Inflammation in Noncardio Embolic Stroke (CONVINCE) NCT02898610	Phase 3, prospective, randomized, open-label	Stroke/TIA (n=2623)	Conventional treatment + colchicine 0.5 mg QD for 60 mo	MACE	60 mo	Ireland
Colchicine After Stroke to Prevent Event Recurrence (CASPER) Registration ID to be confirmed	Prospective, randomized, double-blind, placebo-controlled	Stroke/TIA + hs-CRP >2 mg/L at 4–6 wk after event (n = unknown)	Conventional treatment + colchicine 0.5 mg QD for 60 mo	MACE	To be confirmed	Australia

ACS indicates acute coronary syndrome; AF, atrial fibrillation; AVR, aortic valve replacement; BMS, bare metal stent; CABG, coronary artery bypass graft; DES, drug-eluting stent; hs-CRP, high-sensitivity C-reactive protein; MACE, major adverse cardiac event; NSTEMI, non–ST-segment–elevation myocardial infarction; PCI, percutaneous coronary intervention; POAF, postoperative atrial fibrillation; RFA PVI, radiofrequency ablation pulmonary vein isolation; STEMI, ST-segment–elevation myocardial infarction; and TIA, transient ischemic attack.

Authors and Disclosures

Spyridon G. Deftereos, MD, PhD, Frans J. Beerkens, MD, Binita Shah, MD, MS, George Giannopoulos, MD, PhD, Dimitrios A. Vrachatis, MD, MS, PhD, Sotiria G. Giotaki, MD, Gerasimos Siasos, MD, MS, PhD, Johny Nicolas, MD, Clare Arnott, MBBS, PhD, Sanjay Patel, MBBS, PhD, Mark Parsons, MD, PhD, Jean-Claude Tardif, MD, Jason C. Kovacic, MD, PhD and George D. Dangas, MD, PhD

Medical School, National Kapodistrian University of Athens, Greece (S.G.D., D.A.V., S.G.G., G.S., G.D.D.). Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York (F.J.B., J.N., J.C.K., G.D.D.). VA New York Harbor Healthcare System, New York University School of Medicine, New York (B.S.). Medical School, Aristotelian University, Thessaloniki, Greece (G.G.). The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.A.). Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Australia (C.A., S.P.). Department of Neurology, Liverpool Hospital and Ingham Institute for Applied Medical Research at South Western Sydney Clinical School, University of New South Wales, Australia (M.P.). Montreal Heart Institute, Université de Montréal, Canada (J.-C.T.). Victor Chang Cardiac Research Institute, Darlinghurst, Australia (J.C.K.). St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (J.C.K.).

Correspondence to
George Dangas, MD, PhD, The Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY 10029. Email george.dangas@mountsinai.org

Disclosures
B. Shah reports funding from the Veterans Affairs Office of Research and Development (iK2CX001074) and the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HL146206) for studies of colchicine in coronary artery disease; is on the advisory board for Philips Volcano; and serves as a consultant for Terumo Medical. Dr Tardif has received research grants from Amarin, AstraZeneca, Ceapro, DalCor Pharmaceuticals, Esperion, Ionis, Novartis, Pfizer, RegenXBio, and Sanofi; has received honoraria from AstraZeneca, DalCor Pharmaceuticals, HLS Pharmaceuticals, and Pendopharm; has received minor equity interest from DalCor Pharmaceuticals; and is an author of patents on pharmacogenomics-guided cholesteryl ester transfer protein inhibition, use of colchicine after MI, and use of colchicine in coronavirus infection (Dr Tardiff has waived his rights in patents on colchicine and does not stand to gain financially). The other authors report no conflicts.

Sources of Funding
C.A. holds a National Health and Medical Research Council/Medical Research Future Fund Priority Investigator Grant and an New South Wales Health Early-Mid Career Research Grant (both of which are not for colchicine studies). S.P. holds the following Australian National Health and Medical Research Council/Medical Research Future Fund colchicine grants: COLCARDIO-ACS GA65779, CASPER GA82107, and IMPACT-ICO GA85492. These studies are supported by Aspen Pharmacare Australia, who are providing drug and placebo. S.P. also holds a New South Wales Cardiovascular Health Fellowship to support colchicine research. M.P. receives funding from the National Health and Medical Research Council Program Grant in Stroke (ID 1113352). J.C.K. received funding from the National Institutes of Health (R01HL130423, R01HL135093, R01HL148167-01A1) and a New South Wales health grant (RG194194).