Are vascular or cardiovascular risk increased in patients with gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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An analysis of nationwide data on more than 200,000 English patients indicates that individuals with gout are at increased risk for both heart attack and stroke. The rate ratio for myocardial infarction in patients with gout was 1.82. Rate ratios for stroke were 1.71 for all stroke, 1.68 for ischemic stroke, 1.69 for hemorrhagic stroke, and 2.00 for stroke of unspecified type. Risks were elevated in both men and women and were higher in the younger age groups. [72, 73]

Risk for vascular disease is increased in patients with gout, particularly women, according to a retrospective cohort study from the United Kingdom that included 8386 patients with gout and 39,766 matched controls. Multivariate analysis showed that women with gout had a 25% increased risk for any vascular event compared with women without gout (hazard ratio [HR], 1.25) and increased risks for any coronary heart disease (HR, 1.25) and peripheral vascular disease (HR, 1.89). [74, 75]

Men with gout, compared with those without gout, had a small but significantly increased risk for any vascular event (hazard ratio [HR], 1.06) and an increased risk for any coronary heart disease (HR, 1.08) and peripheral vascular disease (HR, 1.18). Unlike women, men with gout were not at greater risk for angina, transient ischemic attack, or stroke. [74, 75]

In contrast, urate-lowering therapy (ULT) in patients with gout has been linked to reduced risk for both cardiovascular (CV) mortality and all-cause mortality. A prospective case-matched cohort study by Chen et al of Taiwanese patients followed for 6.5 years found that patients with gout who received ULT with either allopurinol or benzbromarone had a lower risk of CV disease (HR 0.29) and all-cause mortality (HR 0.47) relative to patients with gout not treated with ULT. [76]

Similarly, Solomon and colleagues reported a reduced risk of a CV event in patients with gout who take colchicine. Their analysis of data from an electronic medical record database on 1002 gout patients, with a median follow-up of 16.5 months, found that the incidence rates of myocardial infarction, stroke, or transient ischemic attack were 35.6 per 1000 person-years for colchicine users and 81.8 for non-users. Adjusted risk of a CV event was 49% lower with colchicine use (HR 0.51) and all-cause mortality was 73% lower (HR 0.55). [77]

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