Colchicine May Prevent Acute Cardiovascular Events in Gout Patients
SAN FRANCISCO, CA—In patients with gout, chronic colchicine use has no effect on the rate of incident coronary artery disease (CAD), a study presented at the 2015 ACR/ARHP Annual Meeting concluded.
“In conjunction with prior studies suggesting a reduction in acute cardiovascular events among colchicine users, our data suggest that colchicine is likely to act by preventing acute events (eg, plaque rupture, or vascular occlusion post-plaque rupture), rather than by reducing incident CAD,” Susanna Jeurling, MD, Division of Rheumatology, NYU School of Medicine, New York, NY, and colleagues reported.
Using ICD-9 codes, the investigators identified 7,819 patients with gout or hyperuricemia from 2000 to 2009. Of these, 446 users of colchicine and 278 non-users (control group) met the inclusion criteria, representing 2,118 vs. 1,367 years of follow-up. The criteria included microscopic diagnosis of urate crystals, ≥6 of 12 ACR gout classification criteria, a rheumatologist gout diagnosis, or 4 to 5 ACR criteria plus a diagnosis of gout from a primary care physician. Excluded were patients with a diagnosis of CAD at index date.
Pharmacy records were used to determine colchicine users, defined as ≥1 prescription for >30 days, and chart review “identified incident CAD, which was defined as a first positive cardiac stress test or cardiac catheterization, PCI (stent or angioplasty), or CABG in the absence of MI. Incident MI was also recorded,” they reported.
Age, race, ethnicity, body mass index; the presence of hypertension, diabetes, and chronic kidney disease; serum creatinine, LDL, and eGFR levels; active and former tobacco use; and use of allopurinol, aspirin, statin, beta-blockers, and NSAIDs as well as any hypertensive agent was similar between the two groups. A significant difference was found between the groups for hyperlipidemia (P=0.03 for the colchicine arm), HDL (P=0.05), uric acid level (P<0.01), and ACE inhibitor use (P<0.01).
“We found no increased incident CAD prevalence among colchicine users vs. non-users,” Jeurling stated. “Inclusion of incident MI as a criterion for incident CAD did not result in any significant difference between the groups.”
The event per patient-years rate of incident CAD did not vary between the two groups; similarly, no differences in individual components were observed.
Finally, “in multivariate models, after controlling for potential variables, colchicine use still did not impact the risk of incident CAD,” Jeurling concluded. Study authors call for prospective clinical trials to further establish the impact of colchicine on cardiovascular high-risk patients with and without gout.