Colchicine Use in Gout Not Associated With Higher Cardiovascular Event Risk

Compared with patients with gout not receiving colchicine, those receiving colchicine may not be at higher risk for myocardial infarction (MI), stroke, and revascularization, according to findings from a systematic review and meta-analysis published in IHC Heart & Vasculature.

Researchers searched publication databases through January 2021 for studies evaluating cardiovascular complications in the setting of gout and colchicine treatment.

A total of 4 studies published between 2012 and 2020 were included in the current analysis. The pooled study population included 10,026 patients, of whom 6800 received colchicine and 3426 did not.

Stratified by colchicine use, 2 studies reported that patients receiving colchicine had higher urate levels than those who were not receiving colchicine (mean range, 8.3-8.4 vs 7.1-7.6 mg/dL); 1 study reported no difference (mean, 7.8 vs 7.5 mg/dL); and another study did not report on urate levels.

Use vs nonuse of colchicine was not associated with increased risk for stroke (risk ratio [RR], 0.51; 95% CI, 0.15-1.78; I²=91%; P =.29), MI (RR, 0.71; 95% CI, 0.36-1.39; I²=77%; P =.32), percutaneous coronary intervention (RR, 0.83; 95% CI, 0.53-1.29; I²=0%; P =.40), and coronary artery bypass grafting (RR, 1.98; 95% CI, 0.70-5.58; I²=0%; P =.20).

Based on published evidence, researchers observed that colchicine use vs nonuse decreased all-cause mortality risk (RR, 0.58; 95% CI, 0.43-0.79; I²=70%; P =.0005).

In a sensitivity analysis for MI risk, findings were consistent when data from 2 studies that excluded patients without coronary artery disease (CAD) were used (RR, 1.11; 95% CI, 0.83-1.49; I²=0%; P =.49); however, when data from studies that included patients with CAD were used, colchicine use was associated with lower MI risk (RR, 0.41; 95% CI, 0.26-0.65; I²=0%; P =.0001).

Study limitations were the exclusion of certain subgroups of patients in some studies and the nonrandomized observational designs.

The study authors concluded, “Taking into account the observational nature of available studies, the combined data suggests that the rate of MI, stroke, and revascularization procedures are not different in patients [with gout] treated with colchicine when compared to patients [with gout] not treated with colchicine. However, in patients with gout and established CAD, the use of colchicine is associated with decreased risk of MI.”