Drug used to prevent gout attacks may reduce cardiovascular risk, study suggests
A new study published in the Annals of the Rheumatic Diseases, has found that colchicine, a drug used to reduce inflammation in gout flares, may help patients with gout from cardiovascular (CV) events.
The lead study author was Dr Daniel H Solomon, from Brigham and Women’s Hospital and chief of the Section of Clinical Sciences in Rheumatology at Harvard Medical School in Boston, US.
Dr Solomon and his team examined the potential association between colchicine and CV risk and all-cause mortality in gout and found that patients with gout who used colchicine had fewer CV events and lower all-cause mortality than similar patients with gout who did not use the medication.
Using retrospective data from an electronic medical record database linked to claims with Medicare, the health insurance company, from 2006 – 2011, the researchers were able to test the hypothesis that colchicine used would be associated with reduced CV risk in patients with gout, who are otherwise at increased risk for atherosclerosis because of their underlying rheumatoid disease. It was stated that colchicine had previously been studied for secondary prevention of CV events in other subgroups.
The study worked with a cohort including 501 patients with gout who had “new use” colchicine prescriptions and 501 similar patients who did not use the medication with a median follow-up of just over 16 months. Both groups were followed for the primary outcome, a composite of myocardial infarction, stroke, or transient ischemic attack. Secondary outcomes were primary CV events, plus revascularisation procedures and all-cause death.
Researchers reported 28 primary CV events among colchicine users and 82 among nonusers. Incidence rates per 1,000 person-years were 35.6 for users and 81.8 for non-users. After full adjustment, colchicine use was associated with a 49% lower risk in the primary CV outcome, as well as a 75% reduction in all-cause mortality.
Dr Solomon and his team stressed that the results require confirmation in a randomised controlled trial, but that there were implications for doctors treating people with gout. He says, “If providers deem a patient at high risk of CVD (i.e., multiple risk factors), then careful CV risk factor management is critical. This would include controlling blood pressure, lipids, diabetes, and stressing the importance of exercise and weight control. Those are all evidence-based interventions that will lower the risk of future CV events
“Beyond this, it may be worth assessing whether the patient tolerates colchicine 0.6 mg per day. If so, then one might discuss with patients whether using colchicine as additional preventive therapy is worth considering. Colchicine should only be used very cautiously in patients with chronic kidney disease.”
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