Background/Purpose: Gout results from an increased body pool of urate that occurs with hyperuricemia. Although urate-lowering therapy (ULT) is beneficial to prevent gout attack, current recommendations do not advise every patient with gout to receive a ULT. In this study, we evaluated the impact of ULT on the risk of major cardiovascular (CV) events and all-cause mortality among individuals with gout.

Methods: We conducted an incident user cohort study with 1:1 propensity score matching by using the National Health Insurance Service-National Sample Cohort (NHIS-NSC), a Korean population-based cohort of individuals who submitted medical care claims between 2002 and 2013, linked with the results of the National Health Checkup Service in Korea. Incident gout cases were defined as newly used International Classification of Diseases (ICD) code M10 from 2003 to 2013, excluding patients who had an M10 code in 2002. For propensity score matching, age, sex, income, presence of diabetes mellitus, hypertension, hyperlipidemia and atrial fibrillation, smoking, alcohol consumption, body mass index, and Charlson comorbidity index scores were considered. Major CV events were defined as acute myocardial infarction (ICD codes I21 and I22) and stroke (I63).

Results: In the NHIS-NSC cohort, 37730 incident gout cases were identified between 2003 and 2013. Among the cases, 9387 were treated with allopurinol, febuxostat, or benzbromarone more than twice (ULT initiators) and the other 28333 were not (comparators). Of the 9387 and 28333 patients, 948 (10.1%) and 2117 (7.5%), respectively, developed major cardiovascular events in the first 10 years of the disease (mean follow-up: 4.1 years), and 714 (7.6%) and 962 (3.4%), respectively, died in the first 10 years of the disease (mean follow-up: 4.4 years). After propensity score matching, 4034 ULT initiators and 4034 matched comparators were compared. Among the initiators and comparators, 349 and 288, respectively, had new major CV events in the first 10 years of the disease (mean follow-up: 4.1 years), and 23 and 16, respectively, died in the first 10 years of the disease (mean follow-up: 4.3 years). ULT initiation was associated with a higher risk of CV events (matched HR, 1.196; 95% confidence interval [CI], 1.022–1.399) and all-cause mortality (matched HR, 1.355; 95% CI, 1.078–1.702).

Conclusion: The current population-based matched-cohort study does not support the beneficial effects of ULT initiation on the cardiovascular outcomes or all-cause mortality in patients with gout during the first 10 years of the disease. Further study regarding the effects of steady ULT maintenance in the whole population cohort would be needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-urate-lowering-therapy-on-the-risk-of-cardiovascular-events-and-all-cause-mortality-among-individuals-with-gout/