Reacción a "Colchicine use reduces strokes and heart attacks in people with cardiovascular disease, according to a Cochrane review"

The article is of high quality. It belongs to the Cochrane Collaboration, which means that it has a rigorous and reproducible design, with a previously registered protocol. The inclusion criteria are strict, only including randomized clinical trials with ≥6 months of follow-up and an independent, double assessment of risk of bias (RoB2). A comprehensive review of sources (CENTRAL, MEDLINE, EMBASE, FDA, etc.) has been carried out up to February 2025, making it very up-to-date. There are no indications of serious bias or relevant conflicts of interest.

Therefore, in terms of rigor, it is a very comprehensive and methodologically sound review of colchicine in secondary cardiovascular prevention.

The review does not revolutionize knowledge, but it definitively consolidates the evidence accumulated since 2019 (COLCOT, LoDoCo2, CLEAR-SYNTAX trials, etc.) showing that:

• Colchicine consistently reduces the risk of myocardial infarction and stroke (≈25–30% relative reduction).

• It does not alter total or cardiovascular mortality.

• It does not increase serious adverse events, although it does increase mild gastrointestinal effects.

New features and added value:

• It integrates 12 randomized clinical trials and nearly 23,000 patients, doubling the sample size compared to previous meta-analyses.

• It updates the evidence by including the most recent trials (2023–2024).

• It reinforces the benefit in myocardial infarction and stroke with “high-certainty evidence” (according to GRADE).

• It provides a neutral synthesis with no apparent publication bias, something that some previous meta-analyses could not guarantee.

How it fits into current guidelines:

• It confirms and strengthens the recommendation already present in the 2024 ESC European guidelines on chronic coronary syndrome, where colchicine (0.5 mg/day) is a class IIa indication in patients with stable atherosclerotic disease despite optimal treatment.

• It helps consolidate its role as a low-cost, well-tolerated cardiovascular anti-inflammatory.

Implications:

• Clinically, this meta-analysis reinforces colchicine as a safe, inexpensive, and effective tool in secondary prevention, especially in patients with recurrence or persistent inflammation.

• Next steps:

• Better define which subgroups (e.g., by inflammation biomarkers) benefit most.

• Evaluate long-term effects on mortality and quality of life.

• Analyze implementation in real practice (adherence, cost-effectiveness, interactions).

Although robust, the review has some important limitations:

• Indirect evidence on mortality: trials were not designed to detect changes in mortality; follow-up periods (6–80 months, median ~2 years) are relatively short.

• High heterogeneity in gastrointestinal events, indicating variability between studies and making it difficult to quantify risk accurately.

• Selected populations: Most participants were men (≈80%) with stable ischemic heart disease; extrapolation to women, elderly patients, or patients with heart failure is uncertain.

• Lack of data on quality of life and hospitalizations, which are relevant outcomes for clinical practice.

• No subgroup analysis according to residual inflammation (e.g., hsCRP levels). This limits understanding of who benefits most (possibly those with persistent inflammation).

• Treatment duration and adherence: Most trials used colchicine for 1–3 years; its long-term efficacy and safety (>5 years) remain unclear.