Inflammation is now recognised as a central mechanism in atherosclerosis and its clinical complications, shifting coronary heart disease management beyond exclusive lipid lowering and antithrombotic therapy. In this setting, colchicine is a potential low-cost antiinflammatory candidate for cardiovascular prevention. While the CANTOS trial provided proof of principle that targeting inflammation can reduce recurrent cardiovascular events independently of lipid lowering, randomised colchicine trials such as COLCOT and LoDoCo2 showed reductions in major adverse cardiovascular events in patients with recent myocardial infarction and chronic coronary disease, respectively. Later meta-analyses generally confirmed benefit for major adverse cardiovascular events, myocardial infarction, stroke, and coronary revascularisation, although without a consistent mortality reduction and with gastrointestinal intolerance as the most common adverse effect. This review summarises the biological rationale, clinical trial evidence, safety profile, practical use, limitations, and current place of colchicine in coronary heart disease highlighting that colchicine is a real available cheap option for secondary prevention at least in chronic coronary syndromes.