Colchicine (cardiovascular)

Colchicine is a plant-derived alkaloid from the autumn crocus (*Colchicum autumnale*) that exerts anti-inflammatory effects by binding tubulin and disrupting microtubule polymerization, impairing neutrophil migration and inhibiting assembly of the NLRP3 inflammasome — a cytoplasmic complex that generates IL-1β and IL-18, two cytokines linked to atherosclerotic plaque progression. At 0.5 mg once daily — far below doses used in gout — it attenuates chronic vascular inflammation without broad immunosuppression. Its relevance to aging biology rests on inflammaging: the low-grade, sterile inflammatory state that accumulates with age and accelerates cardiovascular disease, making colchicine a pharmacological tool to interrupt one causal pathway linking aging to major adverse cardiovascular events (MACE). Clinical trial evidence is strong: the COLCOT trial (n = 4,745) showed a 23% relative reduction in MACE in patients randomized within 30 days of myocardial infarction (Tardif et al., NEJM 2019); LoDoCo2 (n = 5,522) demonstrated a 31% reduction in cardiovascular events in stable chronic coronary disease over a median 28.6 months (Nidorf et al., NEJM 2020). The FDA approved colchicine 0.5 mg (Lodoco) in June 2023 for secondary cardiovascular prevention. The 2023 AHA/ACC guideline assigns a Class IIb recommendation for patients with residual inflammatory risk; gastrointestinal side effects are the main tolerability concern, and interaction with CYP3A4/P-gp inhibitors requires dose vigilance.