Research advances of colchicine in anti-inflammatory treatment for coronary artery disease.

Atherosclerosis is a chronic inflammatory disease, and anti-inflammatory therapy has become a key strategy for preventing and treating coronary artery disease (CAD). Colchicine, a cost-effective anti-inflammatory drug, can intervene in the atherosclerotic process through multiple mechanisms, such as inhibiting neutrophils and the nucleotide-binding domain, leucine-rich repeat family, pyrin domain-containing protein 3 (NLRP3) inflammasome. Numerous clinical trials have demonstrated that colchicine significantly improves cardiovascular outcomes in CAD patients, reducing the incidence of major adverse cardiovascular events (MACE) such as revascularization and stroke. Current clinical guidelines recommend low-dose colchicine for secondary prevention in chronic CAD. However, trials like CLEAR SYNERGY may yield negative results due to limitations such as design heterogeneity. Although the application value of low-dose colchicine in patients with chronic CAD has been fully established, more comprehensive research is still warranted to clarify its clinical benefits, personalized dosing regimens, and long-term safety profile in other populations. This article reviews the mechanism of action and pharmacological properties of colchicine, provides a detailed analysis of numerous clinical trials and meta-analyses examining its use in different types of CAD, and integrates safety data and guidelines to establish a solid foundation for clinical management. Furthermore, it explores its potential application value in special high-risk populations such as those with diabetes and Clonal Hematopoiesis (CH), offering direction for future precision treatment in this field.