Log in to MyACC
Association Between Gout Flare and Subsequent Cardiovascular Events
Quick Takes
- Among patients with newly diagnosed gout, patients with cardiovascular events had significantly increased odds of a gout flare during the preceding 120 days compared with patients who did not experience cardiovascular events.
- Gout flares are characterized by neutrophil-rich acute inflammation due to NLRP-3 inflammasome activation, which may contribute to plaque destabilization and explain the association between cardiovascular events and recent prior gout flares.
- Whether colchicine or other novel anti-inflammatory agents may effectively and safely mitigate cardiovascular risk in those with gout flares needs further study.
Study Questions:
Are gout flares associated with a transient increase in rates of cardiovascular events (i.e., acute myocardial infarction and stroke)?
Methods:
The investigators conducted a retrospective observational study using electronic health records from the Clinical Practice Research Datalink in England between January 1, 1997, and December 31, 2020. A multivariable nested case-control study was performed among 62,574 patients with gout, and a self-controlled case series, adjusted for season and age, was performed among 1,421 patients with gout flare and cardiovascular event. Gout flares were ascertained using hospitalization, primary care outpatient, and prescription records. The primary outcome was a cardiovascular event, defined as an acute myocardial infarction or stroke. Association with recent prior gout flares was measured using adjusted odds ratios (ORs) with 95% confidence intervals (CIs) in a nested case-control study and adjusted incidence rate ratios (IRRs) with 95% CIs in a self-controlled case series.
Results:
Among patients with a new diagnosis of gout (mean age, 76.5 years; 69.3% men, 30.7% women), 10,475 patients with subsequent cardiovascular events were matched with 52,099 patients without cardiovascular events. Patients with cardiovascular events, compared with those who did not have cardiovascular events, had significantly higher odds of gout flare within the prior 0-60 days (204/10,475 [2.0%] vs. 743/52,099 [1.4%]; adjusted OR, 1.93 [95% CI, 1.57-2.38]) and within the prior 61-120 days (170/10,475 [1.6%] vs. 628/52,099 [1.2%]; adjusted OR, 1.57 [95% CI, 1.26-1.96]). There was no significant difference in the odds of gout flare within the prior 121-180 days (148/10,475 [1.4%] vs. 662/52,099 [1.3%]; adjusted OR, 1.06 [95% CI, 0.84-1.34]).
In the self-controlled case series (n = 1,421), cardiovascular event rates per 1,000 person-days were 2.49 (95% CI, 2.16-2.82) within days 0-60; 2.16 (95% CI, 1.85-2.47) within days 61-120; and 1.70 (95% CI, 1.42-1.98) within days 121-180 after a gout flare, compared with cardiovascular event rates of 1.32 (95% CI, 1.23-1.41) per 1,000 person-days within the 150 days before or the 181-540 days after the gout flare. Compared with 150 days before or the 181-540 days after a gout flare, incidence rate differences for cardiovascular events were 1.17 (95% CI, 0.83-1.52) per 1,000 person-days, and adjusted IRRs were 1.89 (95% CI, 1.54-2.30) within days 0-60; 0.84 (95% CI, 0.52-1.17) per 1,000 person-days and 1.64 (95% CI, 1.45-1.86) within days 61-120; and 0.38 (95% CI, 0.09-0.67) per 1,000 person-days and 1.29 (95% CI, 1.02-1.64) within days 121-180 after a gout flare.
Conclusions:
The authors concluded that gout flares are associated with a transient increase in cardiovascular events following the flare.
Perspective:
This study reports that among patients with newly diagnosed gout, patients with cardiovascular events had significantly increased odds of a gout flare during the preceding 120 days compared with patients who did not experience cardiovascular events. Overall, these findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares. Gout flares are characterized by neutrophil-rich acute inflammation due to NLRP-3 inflammasome activation, which may contribute to plaque destabilization and explain the association between cardiovascular events and recent prior gout flares. There is evidence that blocking IL‑1β inflammatory activity prevented recurrent cardiovascular events but also increased fatal infections [CANTOS; ClinicalTrials.gov Identifier: NCT01327846]. Whether colchicine or other novel anti-inflammatory agents may effectively and safely mitigate cardiovascular risk in those with gout flares needs further study.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Anti-Inflammatory Agents, Cardiovascular Diseases, Colchicine, Electronic Health Records, Gout, Heart Disease Risk Factors, Inflammasomes, Inflammation, Interleukins, Myocardial Infarction, Neutrophils, Outpatients, Primary Prevention, Risk Factors, Stroke, Symptom Flare Up
< Back to Listings
