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A study presented at ACC 2025 found that colchicine use in diabetic patients without CAD significantly reduced 3-year cardiovascular events and mortality.
New research presented at the American College of Cardiology (ACC) 2025 Scientific Sessions adds to evidence suggesting colchicine may reduce cardiovascular event rates even in diabetic patients without established coronary artery disease (CAD).
Although secondary prevention of cardiovascular disease (CVD) in patients with diabetes is well established, primary prevention strategies remain limited. Traditional risk factor modification, targeting hyperlipidemia, hypertension, and glycemic control, has not eliminated the residual cardiovascular risk in this population.
Anti-inflammatory therapy represents a novel preventive approach, but until recently, data on colchicine in primary prevention, particularly among diabetic patients without CAD, were lacking. Identifying therapies that can safely reduce CVD events before they occur is critical, given the high baseline risk in these patients.
Clinical Guidelines & Consensus
Colchicine has demonstrated cardiovascular benefit in previous trials such as COLCOT and LoDoCo2, primarily in patients with established CAD. Current guidelines from the American Heart Association and ACC do not yet include colchicine for primary prevention, largely due to limited data in this area. However, the emerging body of evidence bolstered by the current ACC study may prompt reevaluation in future guideline updates.
A key barrier to colchicine adoption in cardiovascular prevention is the lack of widespread familiarity with its anti-inflammatory properties outside of rheumatology.
“Colchicine is a powerful anti-inflammatory medication, and beneficial effects on cardiovascular outcomes are seen regardless of diabetic status,” explains Mary Greene, MD.
She notes that while colchicine is not prescribed specifically for diabetes, she does use it for cardiovascular risk reduction in appropriate patients. Education and cross-specialty collaboration may help bridge gaps in knowledge and usage.
Colchicine’s Impact
The retrospective cohort study presented at ACC 2025 analyzed more than 917,000 diabetic patients without CAD using the TriNetX database. After propensity score matching, colchicine use was associated with:
- 21% reduction in all-cause mortality (OR, 0.79; P<0.001);
- 89% reduction in acute myocardial infarction (OR, 0.11; P<0.001); and
- 37% reduction in cerebrovascular accidents (OR, 0.63; P<0.001).
Event-free survival at 3 years was also markedly higher among colchicine recipients (0.75 vs. 0.53, P<0.001). These findings suggest a potential role for low-dose colchicine as a preventive therapy in high-risk populations with diabetes.
Educating patients about cardiovascular risk and emerging treatment options is essential. Many patients with diabetes may not perceive themselves to be at imminent risk for CVD. As Dr. Greene notes, therapies like GLP-1 receptor agonists and SGLT2 inhibitors already offer cardiovascular benefit in addition to glucose control.
“Colchicine may be a great adjunct to these medications,” she says.
Empowering patients to understand how these agents work together and discussing the rationale behind their use can foster adherence and improve outcomes.
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