Colchicine in HFpEF

Inclusion Criteria: * Patients ≥ 40 years of age; * Chronic symptomatic HFpEF defined as follows: left ventricular ejection fraction (LVEF) \> or = 45% within 6 months prior to screening visit (regardless of the imaging modality); * No recent change in RAAS inhibitors regimen for at least 1 month before enrolment (excluding changes in oral diuretics); * NYHA functional class II to IV; * Evidence of structural heart disease defined by at least 1 of the following echocardiography findings: LV hypertrophy (i.e. septal or posterior wall thickness ≥1.1 cm) or left atrial enlargement (i.e., width ≥3.8 cm, length ≥5.0 cm, area ≥20 cm2, volume ≥55 ml, or volume index ≥29 ml/m2); * Patients with a diagnosis of acute heart failure (treated with intravenous diuretics) within 12 months before screening; or an NT-proBNP of ≥300 pg/ml if in sinus rhythm, and ≥900 pg/ml if in atrial fibrillation within 30 days before screening (if multiple measurements, consider the highest); * At least one of the following criteria defining chronic enhanced inflammatory milieu: 1. Obesity, defined as body mass index (BMI) \> 30kg/m2, 2. Type 2 diabetes according to Diabetes Canada definition (http://guidelines.diabetes.ca/cpg/chapter3), and regardless of therapy, 3. Evidence of pathological systemic inflammation including: high hs-CRP levels (hs-CRP\>2mg/L), or the combination of high neutrophil count and low lymphocyte count (Neutrophil to Lymphocyte Ratio \>3) within 30 days before screening (if multiple measurements, consider the higher), * Subjects with the capacity to provide informed consent. Exclusion Criteria: * Any prior measurement of LVEF \<40%; * Patients with a diagnosis of hypertrophic or infiltrative cardiomyopathy; * Presence of hemodynamically significant valvular heart disease in the opinion of the investigator; * Presence of active infection within the 3 months prior to visit 1 needing antibiotics (excluding COVID-19); * Acute decompensated HF, acute coronary syndrome (including myocardial infarction), cardiac surgery, other major cardiovascular surgery, or urgent percutaneous coronary intervention (PCI) within the 3 months prior to visit 1; * Elective PCI within 30 days prior to visit 1; * Known or clinically judged significant (i.e., angina with CCS class \>2/4) epicardial coronary artery disease (CAD) that has not been revascularized (revascularized CAD is defined by a history of myocardial infraction, percutaneous intervention, or coronary artery bypass grafting); * Changes renin-angiotensin-aldosterone system (RAAS) inhibitors regimen within 30 days prior to screening visit; * History of hypersensitivity to colchicine; * Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or atrial flutter with a resting ventricular rate \>120 beats per minute; * Any surgical or medical condition that in the opinion of the investigator may place the patient at higher risk from his/her participation in the study or is likely to prevent the patient from complying with the requirements of the study or completing the study; * Evidence of hepatic disease as determined by any 1 of the following: serum glutamate oxaloacetate transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) values exceeding 3× the upper limit of normal, bilirubin\>1.5 mg/dL (\>25.65 μmol/L) at baseline visit; or patient with a history of cirrhosis, chronic active hepatitis or severe hepatic disease; * Patients with estimated glomerular filtration rate (eGFR) \<30 ml/min/1.73 m2 as calculated by the Modification in Diet in Renal Disease (MDRD) formula at baseline visit; * History or presence of any other disease with a life expectancy of \<1 year; * Patient with inflammatory bowel disease (Crohn's disease or ulcerative colitis) or patient with chronic diarrhea; * Patient with pre-existent progressive neuromuscular disease; * Patient currently taking colchicine for other indications (mainly chronic indications represented by Familial Mediterranean Fever or gout). There is no wash-out period required for patients who have been treated with colchicine and stopped treatment prior to enrolment; * Patients currently under long-term steroid medication for a chronic condition, or steroid medication within 30 days before screening; * Patient is considered by the investigator, for any reason, to be an unsuitable candidate for the study. * Positive pregnancy test result at the screening visit, and females of childbearing potential who do not agree to use adequate method of contraception for the duration of the study; acceptable means of birth control include: implantable contraceptives, injectable contraceptives, oral contraceptives, transdermal contraceptives, intrauterine devices, male or female condoms with spermicide, abstinence, or a sterile sexual partner.