A new study suggests a link between common gout medications and increased cardiovascular risk, prompting a reevaluation of treatment protocols. Researchers found patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for gout experienced a significantly higher rate of heart attack, stroke, and cardiovascular death compared to those treated with colchicine. The findings, published in arthritis and Rheumatology, underscore the importance of carefully considering a patient’s heart health when managing the inflammatory arthritis condition, which affects an estimated 9.2 million U.S. adults, according to the CDC.
People with gout may face a significantly increased risk of cardiovascular problems, even after accounting for other known risk factors, according to a new study. Researchers found that using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage gout symptoms was associated with a 56% higher rate of serious cardiovascular events compared to using colchicine.
Gout, a common condition in Western populations, has long been linked to a higher burden of cardiometabolic disease and increased overall mortality. This new research, published in Arthritis and Rheumatology, suggests that the choice of medication for managing gout flares and preventing future attacks could play a crucial role in cardiovascular health.
NSAIDs Linked to Increased Cardiovascular Risk in Gout Patients
The study, which involved over 18,000 adults, compared cardiovascular outcomes in patients newly diagnosed with gout who were prescribed either NSAIDs or colchicine alongside allopurinol – a medication used to lower uric acid levels. Participants were matched based on a scoring system to ensure comparable characteristics between the two groups.
The findings revealed that patients treated with NSAIDs experienced 38.8 more major cardiovascular events – including heart attack, stroke, or cardiovascular death – per 1,000 person-years compared to those treated with colchicine. This translated to a 56% increased risk, with a hazard ratio of 1.56 (95% confidence interval: 1.11–2.17).
Perhaps even more concerning, the researchers observed a more than twofold increase in cardiovascular mortality among those taking NSAIDs. There were 10.9 more cardiovascular deaths per 1,000 person-years in the NSAID group (hazard ratio 2.50, 95% confidence interval: 1.14–5.26). Further analysis confirmed that NSAIDs also increased the risk of major cardiovascular events compared to receiving no preventative medication at all.
Colchicine Shows No Increased Risk, But Limited Benefit
While colchicine has demonstrated cardiovascular benefits in patients with atherosclerosis and even received FDA approval to reduce cardiovascular risk in certain populations, this study did not find a clear cardiovascular benefit when used for gout flare prevention. However, colchicine was not associated with an increased risk of major cardiovascular events compared to no preventative treatment.
The study utilized a “target trial emulation” approach, leveraging a large population database from British Columbia to mimic a randomized controlled trial. This method helps to reduce biases associated with observational studies.
Researchers acknowledge that, as with any observational study, there is a possibility of unmeasured confounding factors, such as smoking status, body mass index, and lipid levels. They also note that patients initially prescribed colchicine tended to have more existing cardiovascular conditions, which could underestimate the true risk associated with NSAIDs. The study also lacked the power to compare the cardiovascular risks of different NSAIDs.
The authors suggest that when initiating allopurinol for gout, healthcare providers should carefully consider the cardiovascular risk profile of their patients. They recommend prioritizing colchicine over NSAIDs whenever possible, aligning with some European guidelines, and reserving NSAIDs for situations where colchicine is contraindicated or not tolerated. They also call for a reevaluation of the safety of even short-term NSAID use during gout flares and a stronger focus on cardiovascular risk stratification when starting allopurinol. This research highlights the importance of a comprehensive approach to gout management that considers not only symptom relief but also long-term cardiovascular health.
