Gout flares linked to transient increase of CVD events

In addition to traditional cardiovascular risk factors, inflammation is a well-known risk factor for cardiovascular diseases (CVDs). Gout is a common inflammatory condition affecting approximately 4% of the general population and particularly prevalent in older people. 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. In addition, patients with gout experience flares, which are recurrent episodes of acute inflammatory arthritis. A new analysis based on records from British medical practices published in the August 2 issue of JAMA, suggests that gout flares, on their own, affect short-term risk for CVD events.

This retrospective observational study was conducted 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. A self-controlled case series based on the same overall cohort involved 1421 patients with both an exposure (gout flare) and outcome (cardiovascular event) which helped to sidestep any potential for residual confounding, an inherent concern with any case–control analysis. 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. 

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 to 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 to 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 to 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 = 1421), cardiovascular event rates per 1000 person-days were 2.49 (95% CI, 2.16-2.82) within days 0 to 60; 2.16 (95% CI, 1.85-2.47) within days 61 to 120; and 1.70 (95% CI, 1.42-1.98) within days 121 to 180 after a gout flare, compared with cardiovascular event rates of 1.32 (95% CI, 1.23-1.41) per 1000 person-days within the 150 days before or the 181 to 540 days after the gout flare. These findings suggest gout flares are associated with a transient increase in cardiovascular events following the flare.


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