COLCHICINE IN CARDIOVASCULAR MEDICINE

Colchicine, a centuries-old anti-inflammatory agent derived from the autumn crocus, has garnered renewed interest in cardiovascular medicine due to its unique pharmacological properties. This review examines the evolution, clinical applications, and controversies surrounding colchicine in cardiovascular care. Beginning with a historical overview, the authors delve into its pharmacokinetics and pharmacodynamics, emphasizing its inhibition of microtubule assembly and reduction of neutrophil and inflammasome activation. The authors elucidated its molecular mechanisms, highlighting its anti-inflammatory effects and role in reducing atherosclerosis, plaque instability, and thrombotic events. Clinical applications are extensively reviewed, showcasing colchicine’s efficacy in preventing recurrent cardiovascular events after myocardial infarction, mitigating inflammation, and reducing the incidence of atrial fibrillation. Strategies for monitoring efficacy and safety, including key biomarkers predicting patient response, are explored. Pivotal trials, such as COLCOT, LoDoCo2, COPS, and COP-AF, are analyzed, demonstrating significant reductions in adverse cardiovascular events and highlighting colchicine’s emerging role in the management of hypertension. Despite its therapeutic promise, controversies persist regarding colchicine’s efficacy in perioperative atrial fibrillation and its side effects, such as diarrhea and lipid profile alterations. These debates are scrutinized, along with considerations for specific populations, particularly those with renal and liver disease. The review also discusses colchicine’s impact on various organ systems, underscoring the need for cautious use in vulnerable populations. In conclusion, this review presents colchicine as a versatile therapeutic agent with significant potential in cardiovascular disease management. However, its narrow therapeutic window and varying effects across different organ systems necessitate careful patient selection and monitoring to optimize clinical benefits and minimize risks.