Background/Purpose:

Recent studies suggest a protective association between both urate lowering medications and colchicine and the risk for coronary heart disease. The goal of the present study was to confirm this.

Methods:

We analyzed data from the Framingham heart study (FHS) spanning 20 years from 1980 to 2000, over 10 study visits (17 to 26) for gout patients only. The definition of Coronar Hert Disease (CHD) included myocardial infarction, coronary insufficiency, angina pectoris and related death. The definition of stroke included thrombotic and hemorrhagic stroke as well as transient ischemic attacks. Gout was defined by any one of: self-report, physician diagnosis, gout medication use, and radiographic changes. Hypertension was defined as systolic blood pressure >= 140 mm Hg or diastolic blood pressure >= 90 mm Hg or usage of anti-hypertensive medications. Diabetes status, BMI and total cholesterol were obtained from FHS official documents. Two types of gout medications (uric acid lowering medications and colchicine) were combined as both have been associated with beneficial cardiovascular effects in prior studies. Data were analyzed using Cox proportional hazard regression models where the dependent variable was the time to incident event and independent variables (gout medication, sex, age, BMI, hypertension, diabetes, total cholesterol) were treated as time-varying. Missing values were addressed by multiple imputations.

Results:

There were 414 participants with gout included in this study, among whom 235 used gout medication before the cardiovascular event. At the baseline the proportion of men was 63.77%. Overall there were 229 incident cases of CHD and 117 incident cases for stroke during the follow up. The incidence rate per thousand person-years of CHD in the gout medication group was 24.74 and in the other group was 27.93; the incidence rates of stroke were 16.78 and 16.93, respectively. The unadjusted and age adjusted hazard ratio for gout medications were 0.88 (95% confidence interval 0.51-1.53) and 0.88 (0.51-1.53) for CHD; 0.87 (0.48-1.56) and 0.87 (0.49-1.57) for stroke.  In multivariable Cox models, gout medication was associated with a hazard ratio of 0.80 (0.45-1.41) for CHD and 0.85 (0.47-1.53) for stroke. When the regressions were repeated for stroke and CHD combined, the multivariable hazard ratio was 0.81 (0.49-1.33).

Conclusion:

Gout medication is associated with a beneficial effect for both incident CHD and stroke in most of our analyses. However the magnitude of the observed statistical association was small and the threshold of statistical significance was not crossed, suggesting that the real-world impact of these drugs may be negligible.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-medications-and-the-risk-for-incident-coronary-heart-disease-and-stroke-the-framingham-heart-study/