Risk factors

Cardiovascular risk of gout flares highlights need for focus on prevention

Gout flares are associated with a small but temporary increased risk of cardiovascular events, a UK study shows.

The case-control study involving 62, 574 patients with gout found patients who experienced a cardiovascular event had significantly greater odds of a recent gout flare in the prior 0 to 60 and 61 to 120 days (adjusted odds ratio [OR] for 0-60 days, 1.93; adjusted OR for 61-120 days, 1.57).

The increased odds persisted when people with pre-existing cardiovascular diseases were excluded and when shorter exposure periods prior to the cardiovascular event (eg, within 0-15 and 16-30 days of cardiovascular event) were considered, reported the research team from the University of Nottingham in JAMA.

They advised that people with recurrent gout flares be considered for long-term urate lowering treatment. 

“Patients should also be considered for concurrent treatment with anti-inflammatory medicines such as colchicine for the first few months because urate lowering treatments may trigger gout flares in the short term”, they said.

According to an accompanying editorial, the findings should alert clinicians and patients to the increased cardiovascular risk in the weeks after a gout flare and should focus attention on optimising preventive measures.

“Clinicians should emphasise the importance of optimising lifestyle measures and standard risk factor control, including adherence to diet, statins, anti-inflammatory drugs (eg, aspirin colchicine), smoking cessation, diabetic and blood pressure control, and antithrombotic medications as indicated. 

The editorialists noted that the incremental risk after a gout flare was small  – at 0.6% over 0-60 days. 

“The small absolute risk has implications for both cost effectiveness and clinical relevance,” they said. 

“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,” they concluded. 

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