Role of Colchicine as Anti-Inflammatory Therapy in HFpEF

Heart failure with preserved ejection fraction (HFpEF) is a complex condition associated with high morbidity and mortality. While its exact causes remain unclear, low-grade systemic inflammation plays a key role by promoting myocardial fibrosis and increasing heart muscle stiffness. Despite this, anti-inflammatory treatments for HFpEF remain largely unexplored.

Colchicine is a well-established anti-inflammatory drug that blocks key inflammatory pathways, including inflammasome activation and the release of interleukin-1 (IL-1). It has demonstrated cardiovascular benefits in trials such as COLCOT and LoDoCo2, significantly reducing the risk of heart-related events in coronary artery disease. However, its effects in HFpEF patients are not yet known.

Two important biomarkers-soluble suppression of tumorigenicity 2 (sST2) and high-sensitivity C-reactive protein (hsCRP)-are strongly linked to worse outcomes in HFpEF. Elevated sST2 reflects increased fibrosis and cardiac stress, while high hsCRP indicates systemic inflammation. Both markers are associated with more severe symptoms and a higher risk of complications. Additionally, the 6-minute walk test (6MWT) is a widely used measure of physical function and exercise capacity in heart failure patients.

This single-center, prospective clinical trial aims to evaluate the effects of colchicine in HFpEF patients with elevated inflammation. Participants will receive colchicine for three months, with assessments of sST2, hsCRP, and 6MWT performance before and after treatment. Findings from this study may provide valuable insights into whether colchicine can reduce inflammation and improve functional capacity in HFpEF patients.

Inclusion criteria

• Adult ≥ 18 years of age, males and females.
• Left Ventricular Ejection Fraction (LVEF) ≥ 50%.
• Symptoms and/or signs of heart failure.
• H2FPEF score ≥ 6 points or HFA-PEFF score ≥ 5 points.
• N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 pg/mL at baseline (patients with atrial fibrillation at baseline NT-proBNP ≥365 pg/mL), or objective evidence of systemic or pulmonary congestion.
• Stable medical therapy within the last 1 month.

Exclusion criteria

• Patients requiring colchicine for other conditions or with a history of colchicine intolerance or hypersensitivity.
• Active or chronic inflammatory diseases or infection.
• Presence of active solid tumors or hematological malignancies.
• Estimated glomerular filtration rate (eGFR) <35 mL/min/1.73 m².
• Severe liver disease includes Child-Pugh class B or C, cirrhosis, or chronic active hepatitis.
• Concurrent use of strong CYP3A4 or P-glycoprotein inhibitors.
• Presence of blood dyscrasias.
• Recent major cardiovascular events or procedures within the last 3 months.
• Established diagnosis of pericardial disease, myocarditis, hypertrophic cardiomyopathy, and cardiac amyloidosis
• Significant valvular heart disease.
• Lack of informed consent.