Cardiovascular events are more likely to occur in the weeks after a gout flare, a new study finds.
Using the 1997-2020 Clinical Practice Research Datalink from England, investigators identified patients with a new diagnosis of gout. They matched 10,475 patients who experienced a stroke or acute myocardial infarction after gout diagnosis to 52,099 patients who did not have a cardiovascular event by age, sex, and gout duration.
Investigators found that a recent gout flare had occurred in a higher proportion of patients who did vs did not experience a stroke or acute myocardial infarction: 2.0% vs 1.4% at 0-60 days and 1.6% vs 1.2% at 61-120 days before the cardiovascular event. The odds of previous gout flare within 60 days and 61-120 days of a cardiovascular event were significantly increased 1.9- and 1.6-fold, respectively, Edoardo Cipolletta, MD, of Nottingham City Hospital in the United Kingdom, and colleagues reported in JAMA. There was no significant correlations between these cardiovascular events and previous gout flare beyond the 120 day period.
To confirm an association, the investigators performed a self-controlled case series including 1421 patients with gout flare who subsequently had a stroke or acute myocardial infarction. The odds of these cardiovascular events (per 1000 person-days) were 2.5-, 2.2-, and 1.7-fold higher within 60, 61-120, and 121-180 days of a gout flare, respectively. The likelihood of cardiovascular events increased 1.9-, 1.6-, and 1.3-fold within 60, 61-120, and 121-180 days of a gout flare, respectively, compared with before a gout flare or more than 6 months after it.
“These findings suggest gout flares are associated with a transient increase in cardiovascular events following the flare,” Dr Cipolletta’s team concluded.
In an accompanying editorial, Jeffrey L. Anderson, MD, and Kirk U. Knowlton, MD, of Intermountain Heart Institute in Salt Lake City, Utah, commented that these findings “reinforce the basic hypothesis that systemic inflammatory disease activity can facilitate vascular inflammation, which is now accepted as a key promoter of acute vascular events.”
They suggested that clinicians reinforce preventative measures such as adherence to dietary recommendations, use of statins, anti-inflammatory drugs (such as aspirin and colchicine), and antithrombotic medications, diabetes and blood pressure control, and smoking cessation. Clinicians should also remind patients to be alert for the signs and symptoms of ischemic stroke, acute myocardial infarction, and unstable angina.
“Preventing gout flares with diet and uric acid lowering likely represents the most important therapeutic opportunity to reduce gout flares and their associated risk of cardiovascular events,” the editorialists wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association between gout flare and subsequent cardiovascular events among patients with gout. JAMA 328(5):440-450. Published online August 2, 2022. doi:10.1001/jama.2022.11390
Anderson JL, Knowlton KU. Cardiovascular events and gout flares. JAMA 328(5):425-426. Published online August 2, 2022. doi:10.1001/jama.2022.9165