Patients with gout are more likely to experience cardiovascular event following flare
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Patients with gout are more likely to experience a cardiovascular event following a flare, according to data published in JAMA.
“In addition to traditional cardiovascular risk factors, inflammation is an important risk factor for cardiovascular diseases,” Edoardo Cipolletta, MD, of the department of academic rheumatology at the University of Nottingham, in the United Kingdom, and co-authors wrote.
“Gout is characterized by low-grade inflammation with elevated concentration of proinflammatory cytokines and reactive oxygen species, formation of neutrophil extracellular traps, endothelial dysfunction and platelet hyperactivity that may precipitate atherothrombosis,” they added. “Gout flares are characterized by inflammation due to activation of the NALP3 inflammasome. In a randomized clinical trial, blocking the NALP3 inflammasome prevented recurrent cardiovascular events.”
To investigate the impact of gout on the occurrence of cardiovascular events, researchers used data from the Clinical Practice Research Datalink in England. Patients aged 18 years or older who had a diagnosis of gout and contributed “research-quality data” to the database were included in the analysis, which included cases from Jan. 1, 1997, to Dec. 31, 2020. The researchers used a nested case-control study and a self-controlled case series.
In the nested case-controlled study, patients with a new gout diagnosis were followed from the date of the diagnosis to the earliest date of a cardiovascular event, or until they were transferred out of the practice, died or the study concluded. Control patients were those who did not experience a cardiovascular event during follow-up, with up to five matched controls for each case. Additionally, the researchers studied gout flares as the exposure points of interest.
For the self-controlled case series, patients with both gout flare exposure and a cardiovascular event were included. In these cases, the exposure window spanned the time of the clinical consultation for the flare to 180 days post-examination. The primary outcome in both series was the occurrence of a cardiovascular event, defined as acute myocardial infarction or stroke. Secondary outcomes included the occurrence of a fatal cardiovascular event or an acute myocardial infarction or stroke.
In total, the analysis included 10,475 patients with gout who experienced cardiovascular events and 52,099 patients who did not experience cardiac events. Patients who had cardiovascular events demonstrated “significantly higher odds” of gout flare before the event. Patients experiencing a flare within 0 to 60 days were more likely than their counterparts to have an event (OR = 1.93; 95% CI, 1.57-2.38). The same was true for patients who experienced a flare in the 61 to 120 days prior to their event (OR = 1.57; 95% CI, 1.26-1.96). There was no significant difference in patients who had a flare in the previous 121 to 180 days.
There were 1,421 patients in the self-controlled series. Here, the rate of cardiovascular events per 1,000 person-days was 2.49 (95% CI, 2.16-2.82) in days 0 to 60 following a gout flare, 2.16 (95% CI, 1.85-2.47) in days 61 to 120 and 1.7 (95% CI, 1.42-1.98) in days 121 to 180.
“The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events,” Abhishek Abhishek, PhD, a professor in the school of medicine at the University of Nottingham, and lead author of the study, said in a press release provided to Healio. “These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares.”
Abhishek added, “People with gout should be encouraged to adopt a healthy lifestyle with appropriate treatment of conditions such as high blood pressure, high cholesterol, obesity and diabetes to minimize their background risk of heart attack and stroke.”
References:
Flare-ups of gout are linked to heart attack and stroke, says new study. August 2, 2022. Accessed August 1, 2022.
Hansildaar R, et al. Lancet Rheumatol. 2020;doi: 10.1161/01.CIR.0000129535.04194.38.
Willerson JT, et al. Circulation. 2004;doi:10.1161/01.CIR.0000129535.04194.38.