CONSISTENT COLCHICINE USE IS ASSOCIATED WITH DECREASED MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH GOUT AND ESTABLISHED CARDIOVASCULAR DISEASE
Authors: Ho G et al.
It’s well accepted that patients with gout have a higher risk for cardiovascular disease (CD). Colchicine has proven efficacy for the secondary prevention of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and has retrospectively been associated with reduced MACE in the general gout population. The objective of this study is to evaluate the association between colchicine use and MACE in gout patients with established CAD.
This retrospective cohort study followed patients with gout and established CAD and compared users of colchicine with non-users (minimum > 30 continuous days prescription). The primary outcome was first a MACE event, defined as non-fatal MI, coronary artery bypass graft, non-fatal stroke, or all-cause mortality. Pre-specified subgroup analyses assessed associations by percentage of time on colchicine.
On primary analysis, the odds of MACE were not decreased with colchicine use (OR 1.28;95% CI [0.69-2.35]). However, due to widely varying degrees of colchicine use, colchicine users were next separated into quartiles by percentage of time on colchicine: Quartile 1 (11.4%), Quartile 2 (31.3%), Quartile 3 (56.6%), and Quartile 4 (88.5%). Patients in Quartile 4 demonstrated significantly lower odds of MACE compared to those in the lowest three Quartiles (OR 0.35; 95% CI [0.13-0.93]).
Among patients with gout and CAD receiving colchicine, those with the most consistent colchicine use (> 70% of observation period on colchicine) had lower odds of MACE when compared to less consistent use. These findings could imply to treat patients with gout and concomitant cardiovascular disease with colchicine long-term and not only in the first months after starting a urate lowering therapy as flare prophylaxis. To support this data prospective trials are needed.