Inflammation contributes to atherosclerosis progression, and colchicine has demonstrated cardiovascular event reduction in stable coronary artery disease (CAD). The EKSTROM trial evaluated whether low-dose colchicine, added to standard therapy, affects coronary plaque components in patients with stable CAD.

In this prospective, randomized, double-blind, placebo-controlled study published in the European Heart Journal: Cardiovascular Imaging, 84 patients were assigned to colchicine 0.5 mg daily or placebo for 12 months. All participants had documented CAD by coronary angiography, CT coronary angiography, or a coronary artery calcium score >400. Seventy-two patients completed follow-up (mean age 64.6 ± 7.3 years; 88% male). Baseline demographics, cardiovascular risk factors, medications, vitals, and inflammatory markers were not significantly different between groups, except for higher use of hypertension medications in the colchicine group (75% vs 44%) at study initiation.

The primary endpoint, change in low-attenuation plaque (LAP) volume assessed by serial coronary CT angiography, showed no statistically significant difference between colchicine and placebo (median change 0.1 [IQR −0.2, 0.2] vs 0.0 [−0.2, 0.3]; unadjusted P=0.342), including multivariable analysis. The secondary endpoint, percent atheroma volume (PAV%), was lower at 12 months in the colchicine group (0.3 [−0.1, 1.3] vs 1.4 [0.4, 2.6]; P=0.008), remaining significant after adjustment (P=0.015). Dense calcified plaque was significantly reduced. Trends toward regression in non-calcified and fibro-fatty plaque were observed. Inflammatory markers decreased but did not reach statistical significance. Colchicine was well tolerated without major safety concerns.

In this stable, well-treated CAD population, low-dose colchicine did not significantly change low-attenuation plaque volume but was associated with lower percent atheroma volume at 12 months.