medwireNews: Regular allopurinol use and keeping serum urate levels within the target range may be associated with a reduced risk for cardiovascular events in men with gout and no history of cardiovascular disease (CVD), observational study findings indicate.
By contrast, colchicine use may be linked to an increased CVD risk in this group of men, report Ken Cai (The University of Auckland, Aotearoa New Zealand) and co-authors in BMJ Medicine.
Their findings are based on an analysis of national registry data for 942,416 residents of the Auckland/Northland region of Aotearoa New Zealand who were aged 20–79 years with no history of ischemic heart disease, ischemic or hemorrhagic stroke, transient ischemic attack, peripheral vascular disease, or heart failure.
Of these, 3.4% had gout overall, with rates of 1.2% among the 517,728 women and 6.0% among the 424,688 men.
Between 2012 and 2016, cardiovascular events were reported in 11.0% and 8.5% of the women and men with gout, respectively, and in 1.9% and 3.2% of their gout-free counterparts.
After adjustment for potential confounders such as age, ethnicity, socioeconomic status, diabetes, and medication use, the researchers found that having gout was associated with a significant 34% increased risk for CVD in women and a significant 18% increased risk in men.
Further analyses revealed that men with gout who were not regular allopurinol users had a significant 15% higher risk for CVD than those who were regularly dispensed the drug. In addition, men with gout and a serum urate level above the treatment target of 0.36 mmol/L had a significant 16% higher risk for CVD than those with a below-target serum urate level.
This suggests that “[i]n people with gout and no history of cardiovascular disease, regular allopurinol dispensing and serum urate at treatment target levels could have an additional cardiovascular benefit beyond treatment of joint disease,” Cai et al remark.
However, they note that “[t]he potential causal mechanisms of these associations require further exploration.”
The team also found that men with gout who were not given colchicine had a significant 16% lower risk for CVD than those who received colchicine.
There were no such associations in women.
Specifically discussing their cohort, Cai and colleagues remark: “In Aotearoa New Zealand, Māori and Pacific Island people have the highest prevalence of gout, are least likely to be taking regular allopurinol, and have the highest burden of cardiovascular risk factors.”
They add: “With the additive risk factor of gout, our findings highlight the importance of resolving inequities in these population groups through access to timely and culturally safe care.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group