Risk of Cardiovascular Event Heightened in Months Following a Gout Flare

Patients with gout experiencing a flare-up were at a heightened risk of myocardial infarction and stroke in the 4 months followings the gout flare-up, according to the results of a new study.

A study of 62,574 patients with gout, results demonstrate patients who experienced a gout flare-up had a nearly doubling in risk of a cardiovascular event in the 60 days following the flare-up, with residual risk noted up to 120 days after the initial gout flare-up.

“The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares,” said lead investigator Abhishek Abhishek, PhD, a professor of rheumatology at the University of Nottingham and honorary consultant rheumatologist at the Nottingham University Hospital, in a statement.

Using data recorded within the Clinical Practice Research Datalink (CPRD) from 1997-2020, investigators designed a study using a nested case-control study and also a self-controlled case series in which patients served as their own controls. From the CPRD, which is a longitudinal primary care database of EHR data from more than 700 general practices in the UK, investigators identified 96,153 patients with newly diagnosed gout during the period of interest.

The 96,153-patient cohort identified for inclusion had a mean age of 76.5 years, 69.3% were men, and 10,475 had a subsequent cardiovascular event. For the purpose of analysis, the 10,475 patients who experienced a cardiovascular event were matched with 52,099 patients without a cardiovascular event. The self-controlled car series included 1421 patients with atrial least 1 gout flare and at least 1 cardiovascular event after the diagnosis of gout.

Upon analysis, results suggested patients with cardiovascular events had significantly greater odds of experiencing a gout flare within the prior 0 to 60 days (aOR, 1.93 [95% CI, 1.57-2.38]) and within the prior 61-120 days (aOR, 1.57 [95% CI, 1.26-1.96]) compared to those who did not experience a cardiovascular event. This risk was not observed for gout flares occurring within 121-180 days after a gout flare (aOR, 1.06 [95% CI, 0.84-1.34]). In the self-controlled case series, cardiovascular event rates per 1000 person-days were 2.49 (95% CI, 2.16-2.82) 0-60 days within a gout flare, 2.16 (95% CI, 1.85-2.47) 61-120 days after a shout flare, 1.70 (95% CI, 1.42-1.98) 121-180 days after a gout flare, compared to a rate of 1.32 (955 CI, 1.23-1.41) within the 150 days before or the 181-540 days after a gout flare.

Further comparison to the 150 days preceding and 181-540 days after gout flare the differences in observed incidence rate differences for cardiovascular events per 1000 person-days and adjusted condense rate ratios were:

• 0-60 Days: 1.17 (95% CI, 0.83-1.52) and 1.89 (95% CI, 1.54-2.30)
• 61-120 Days: 0.84 (95% CI, 0.52-1.17) and 1.64 (95% CI, 1.45-1.86)
• 121-180 Days: 0.38 (95% CI, 0.09-0.67) and 1.29 (95% CI, 1.02-1.64)

In an editorial published in JAMA, Jeffrey L. Anderson, MD, and Kirk U. Knowlton, MD, both of the Intermountain Heart Institute at Intermountain Healthcare, provided perspective on the real-world implications of the current study for clinical practice.

“The findings of the study by Cipolletta et al should alert clinicians and patients to the increased cardiovascular risk in the weeks beginning after a gout flare and should focus attention on optimizing preventive measures. Patients should be alert to the signs and symptoms of unstable angina, MI, and ischemic stroke so that medical care can be emergently sought,” wrote Anderson and Knowlton. “Clinicians should emphasize the importance of optimizing lifestyle measures and standard risk factor control, including adherence to diet, statins, anti-inflammatory drugs, smoking cessation, diabetic and blood pressure control, and antithrombotic medications as indicated. However, to keep this increased risk in perspective, the incremental risk after a gout flare was small (0.6% over 0-60 days).”

This study, “Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout,” was published in JAMA.