Gout flares may precede cardiovascular events

A recent gout flare may be associated with increased odds of a cardiovascular (CV) event, a retrospective study found.

Researchers conducted the observational study using electronic health records from the Clinical Practice Research Datalink in England from 1997 through 2020. They performed a multivariable nested case-control study among 62,574 patients with gout, as well as a self-controlled case series, adjusted for season and age, among 1,421 patients with a gout flare and a CV event. The primary outcome was a CV event, defined as an acute myocardial infarction or stroke. The researchers ascertained gout flares and CV events using hospitalization, primary care outpatient, and prescription records. Results were published Aug. 2 by JAMA.

Among patients with a new diagnosis of gout (mean age, 76.5 years; 30.7% women), 10,475 patients with subsequent CV events were matched with 52,099 patients without CV events. Patients with CV events, compared to those without, had significantly higher odds of gout flare within the prior 0 to 60 days (2.0% vs. 1.4%; adjusted odds ratio [OR], 1.93 [95% CI, 1.57 to 2.38]) and within the prior 61 to 120 days (1.6% vs. 1.2%; adjusted OR, 1.57 [95% CI, 1.26 to 1.96]). However, there was no significant difference in the odds of gout flare within the prior 121 to 180 days (1.4% vs. 1.3%; adjusted OR, 1.06 [95% CI, 0.84 to 1.34]). In the self-controlled case series, CV event rates per 1,000 person-days were 2.49 (95% CI, 2.16 to 2.82) within days 0 to 60 after a flare; 2.16 (95% CI, 1.85 to 2.47) within days 61 to 120; and 1.70 (95% CI, 1.42 to 1.98) within days 121 to 180, compared with CV event rates of 1.32 (95% CI, 1.23 to 1.41) per 1,000 person-days within the 150 days before or the 181 to 540 days after the gout flare. Compared with 150 days before or the 181 to 540 days after a gout flare, the incidence rate differences for CV events were 1.17 (95% CI, 0.83 to 1.52) per 1,000 person-days within 0 to 60 days after a gout flare, 0.84 (95% CI, 0.52 to 1.17) within days 61 to 120, and 0.38 (95% CI, 0.09 to 0.67) within days 121 to 180 after a gout flare, with adjusted incidences of 1.64 (95% CI, 1.45 to 1.86) , 1.89 (95% CI, 1.54 to 2.30), and 1.29 (95% CI, 1.02-1.64), respectively.

Limitations of the study include the fact that data were extracted retrospectively from a prospective database, the authors noted. They added that it was not possible to clinically verify or validate each CV event.

The findings should alert clinicians and patients to the increased CV risk in the weeks after a gout flare and should place a focus on optimizing preventive measures, an accompanying editorial said.

“Clinicians should emphasize the importance of optimizing lifestyle measures and standard risk factor control, including adherence to diet, statins, anti-inflammatory drugs (eg, aspirin, colchicine), smoking cessation, diabetic and blood pressure control, and antithrombotic medications as indicated,” the editorialists wrote. “However, to keep this increased risk in perspective, the incremental risk after a gout flare was small (0.6% over 0-60 days).”