Gout Associated With Worse Outcomes in Obstructive Coronary Artery Disease

An increased risk for worse outcomes in obstructive coronary artery disease (CAD) exists for patients with a clinical history of gout, even with high levels of optimal baseline medical therapy for cardiovascular disease (CVD), according to a study published in the Journal of the American Heart Association.

Researchers in the current study assessed the association between gout and CVD for patients with obstructive CAD by analyzing data from the Duke Databank for Cardiovascular Diseases. This follow-up data concerned patients with obstructive CAD undergoing cardiac catheterization at the Duke University Medical Center between 1998 and 2013.

Adjusting for differences in clinical factors at baseline, researchers assessed the relationship between gout diagnosis and the primary composite outcome time to the first event of a stroke, myocardial infarction, or CV death, along with secondary end points for time to all-cause mortality and CV death.

Out of 17,201 patients, 8.2% (n=1406) had baseline gout paired with a high CV risk factor burden, while also having high rates of optimal CV medical therapy. With a median follow-up period of 6.4 years, gout diagnosis at the time of cardiac catheterization was not associated with the study’s primary outcome (HR, 1.05; 95% CI, 0.96-1.15; P =.31) or with CV death (HR, 1.10; 95% CI, 0.99-1.22; P =.08).

Gout diagnosis at baseline was associated with increased all-cause mortality, however (HR, 1.13; 95% CI, 1.05-1.23; P =.002). After new, post-baseline diagnoses of gout were included, prior gout diagnosis was significantly associated with risk of the primary outcome (HR, 1.15; 95% CI, 1.07-1.25; P =.0004).

Study investigators conclude that “a clinical history of gout, at either the time of catheterization or any point thereafter, is associated with worse long-term cardiovascular outcomes… despite relatively high levels of optimal medical therapy… Whether targeted anti-inflammatory therapy or better control of gout can improve cardiovascular outcomes could be topics of future investigation.”

Disclosures: Study funding was provided by Ironwood Pharmaceuticals, Inc, and Ardea Biosciences, Inc.

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Reference

Pagidipati NJ, Clare RM, Keenan RT, Chiswell K, Roe MT, Hess CN. Association of gout with long-term cardiovascular outcomes among patients with obstructive coronary artery disease. [published online  August 21, 2018] J Am Heart Assoc. doi: 10.1161/JAHA.118.009328