Study Reveals Temporal Link Between Acute Gout Episodes and Major Adverse Cardiovascular Events

A new study in ARC Open Rheumatology shed light on the temporal relationship between acute gout episodes and major adverse cardiovascular events (MACE). While the association between gout and cardiovascular disease has already been recognized, “the mechanism by which cardiovascular risk arises in patients with gout is poorly understood,” the authors of the study wrote.

Researchers utilized data from the Western Australian Rheumatic Disease Epidemiology Registry, extracting information from the Hospital Morbidity Data Collection and Death Registrations. They then identified patients with incident acute gout who were admitted to the hospital and subsequently experienced MACE (eg, heart attack, strokes). To investigate the relationship between acute gout and MACE, a self-controlled case-series design was employed, which allowed for within-person analysis while controlling for patient-specific confounding factors.

A total of 941 patients (average age, 76.4 years; 66.7% were male) were included in the study. Among these patients, 898 (95%) experienced MACE during the control period, which covered 1 year before the acute gout admission and 1 year after the postdischarge period. Additionally, 112 patients (12%) experienced MACE during the 30-day postdischarge period following the acute gout admission. The rates of MACE were found to be 0.84 events per person-year during the control period; during the postdischarge period, the rate increased to 1.45 events per person-year. Statistical analysis confirmed a significantly increased risk of MACE during the 30-day postdischarge period compared with the control period.

“This study provides support to the hypothesis that systemic inflammation seen in gout is associated with the increased risk of MACE in that population,” the researchers remarked. The observed increased risk of MACE during the first 30 days following an acute gout hospital admission highlights the potential role of acute inflammation in triggering cardiovascular events. These results suggest that the inflammatory processes underlying gout may contribute to the development of cardiovascular disease in patients with gout.

While the study provided valuable insights, it also has several limitations, primarily related to the self-controlled case-series design. “One assumption of the SCCS is that recurrent adverse events must be independent, in that the occurrence of one cardiovascular event must not alter the probability of a subsequent event occurring,” they conceded. Additionally, this study does not possess information on pharmacotherapy administered for acute gout within this group, potentially introducing confounding factors to the outcomes.

The findings suggest a temporal association between acute gout inflammation and subsequent cardiovascular events, highlighting the need for proactive cardiovascular risk management in patients with gout. Health care providers should be aware of the potential cardiovascular implications of acute gout episodes and ensure appropriate monitoring and treatment to mitigate the risk of MACE in this patient population. The researchers encouraged “further investigation into the relationship between acute inflammation and MACE in gout is required, including the impact of anti-inflammatory therapy.”

Source: ARC Open Rheumatology