Background/Purpose: Gout patients are at increased risk for CV disease, possibly owing to chronic inflammation. Colchicine is commonly used in gout, and inhibits inflammatory cell types that are also implicated in atherosclerosis. In a cross-sectional study, we observed an association between colchicine use and decreased myocardial infarction (MI) among gout patients (Crittenden et al, J Rheum 2012). To further assess colchicine’s possible effect on CV risk in this population, we performed a retrospective cohort study of gout patients taking or not taking colchicine at the VA NY Harbor Health Care System.

Methods: We identified all active patients with ICD-9 codes for gout or hyperuricemia from 2000-09. Charts were manually screened to confirm gout (based on ACR criteria) and pharmacy records used to identify subjects taking daily colchicine for > 30 continuous days (colchicine group). Gout patients who never received colchicine formed the control group. Among the colchicine group, we defined colchicine lapse as any period of colchicine non-use ≥ 2 weeks after medication cessation (to account for drug elimination time). Outcomes included a composite incidence rate of MI+stroke+transient ischemic attack (TIA); individual components of the composite outcome; and C-reactive protein level (CRP; lowest level attained during the period observed).

Results: Of 7,819 potential subjects, 1638 patients met gout criteria. 381 were excluded for < 30 days colchicine use, leaving 1257 to be analyzed. 804 colchicine users had 3,630 years of follow-up (2270 years of active use and 1360 years of lapse). 453 patients never used colchicine, with 2,087 years of follow-up. Colchicine users had significantly more hyperlipidemia (60 vs 49%, p=0.003), and history of MI (14 vs 9 %, p=0.01) and percutaneous intervention (10 vs 6%, p=0.006) than controls, as well as higher urate levels (8.5 vs 8.0 mg/dL, p=0.05) and allopurinol use rates (23 vs 18%, p=0.03). We observed no significant difference between colchicine users and non-users for the composite outcome (control, 0.011 events/subject-year; colchicine, 0.016 events/subject-year, p=0.23) or individual component outcomes (adjusted for allopurinol use), but due to a low event rate we were not able to adjust fully for patient risk factors. However, within the colchicine group we observed a significant, 57% reduction in the composite outcome event rate during times of active colchicine use vs lapse (0.012 vs 0.021 events/subject-year, p=0.04). When colchicine users were divided into consistent (medication possession ratio ≥ 0.9) vs inconsistent (MPR < 0.9) users, consistent colchicine users had lower CRP levels (0.7 mg/dL) than either never users (2.7 mg/dL) or inconsistent users (1.9 mg/dL) (never vs consistent p<0.001, inconsistent vs consistent p<0.001), despite higher background CV risk. 

Conclusion: Among gout patients prescribed colchicine on an ongoing basis, composite CV event rates were significantly lower during colchicine use vs colchicine lapse, and consistent colchicine use was associated with lower CRP concentrations. Additional studies are underway to clarify the possible benefit of colchicine in reducing acute CV events among gout patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/colchicine-and-the-risk-of-acute-cardiovascular-cv-events-among-gout-patients-the-new-york-department-of-veterans-affairs-retrospective-cohort-study/