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ACC 25: The EKSTROM Trial: Colchicine on the Progression of Known Coronary Atherosclerosis in Stable CAD
Published: 31 Mar 2025
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ACC 2025 - Outcomes from colchicine in patients with stable coronary artery disease (CAD) shows significant plaque volume progression compared to placebo at one year.
Dr Matthew Budoff (UCLA Medical Centre, Los Angeles, US) joins us onsite at ACC 2025 to discuss findings from the randomized, placebo-controlled, investigator-initiated EKSTROM trial (NCT06342609; Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center). EKSTROM aimed to investigate the effect of colchicine on the progression of known coronary atherosclerosis in patients with stable CAD. The primary outcome measure was the rate of change in low attenuation plaque volume.
Low attenuation plaque was not significantly reduced, however, colcicine significantly reduced total plaque volume progression by 1.1% compared to placebo at one year. Colcicine treatment demonstrated trends towards regression of non-calcified plaque, fibrous and fibro-fatty plaque and significantly slowed dense calcium progression.
Interview Questions:
- What is the reasoning behind the EKSTROM trial?
- What was the study design and patient population?
- What were the key findings?
- Were there any surprising or unexpected results?
- What are the take-home messages for practice?
- What are the next steps?
Recorded on-site at ACC in Chicago, 2025.
Editors: Yazmin Sadik, Jordan Rance
Videographers: Tom Green, David Ben-Harosh
Support: This is an independent interview produced by Radcliffe Cardiology.
" I'm Matthew Budoff. I'm a preventive cardiologist and a professor of medicine at the UCLA School of Medicine.
Yeah, so, you know, we want to do a trial with low dose colchicine in stable coronary patients. I think there's still a little bit of confusion about the potential benefits of colchicine therapy as an add on to things like statins and other treatments. So we wanted to do a prospective randomised trial looking at plaque progression to see if it affected atherosclerosis.
So we took patients with stable coronary disease, we randomised them to either Low dose Colchicine, 0.5 milligrammes once a day or a placebo and did a serial CT angiography. So we did a CT angiogram of the coronary arteries at baseline. We followed them for a year on treatment and then did a follow up study at the end of 12 months to look at changes in plaque over the course of a year.
Yeah. So we found that low dose colchicine reduced plaque atheroma volume, or PAV percent by over 1%, which is considered a very significant amount in the intravascular ultrasound literature. A 1% change in PAV resulted in a was equivalent to a 25% event reduction. So our study strongly supports the Lodoco2 trial and the Colcat studies that showed 23 to 31% event reduction with the use of colchicine.
Well, you know, we saw two big changes, one in percent atheroma volume and one in dense calcification. So we actually saw a lower prevalence of calcification, which might go along with the anti inflammatory effects. C reactive protein did go down significantly, but I think it definitely reinforces the mechanistic benefits of anti inflammatories by showing that we can reduce inflammation and reduce atherosclerosis simultaneously.
Yeah. So I would say that for patients who have underlying atherosclerosis who have elevated C reactive protein, or you're worried about them from an inflammatory perspective, low dose colchicine was both safe and effective at helping reduce plaque atheroma.
Yeah. So you know, this was a small funded study from the Stanley Ekstrom Foundation. It was limited to 84 patients enrolled. So we need to really do larger and longer studies. But I do think that this does add to the existing literature in stable cad, the benefits of colchicine therapy.”
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