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The following is a summary of “Cardiovascular events in patients with gout initiating urate-lowering therapy with or without colchicine for flare prophylaxis: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data,” published in the March 2025 issue of Lancet Rheumatology by Cipolletta et al. 

Urate-lowering therapy can trigger gout flares, which temporarily increase cardiovascular risk. 

Researchers conducted a retrospective study to assess cardiovascular risk in patients with gout starting urate-lowering therapy with or without colchicine. Colchicine use was linked to a lower cardiovascular risk. 

They conducted a retrospective new-user cohort study using Clinical Practice Research Datalink Aurum, linking primary care, hospitalization, and mortality records. Patients with gout initiating urate-lowering therapy were included, comparing those prescribed colchicine prophylaxis (≥21 days) with those without prophylaxis. The primary outcome was myocardial infarction or stroke within 180 days. Propensity scores overlaps weighting, Cox regression, intention-to-treat, and per-protocol analyses with inverse probability of censoring weighting were used. Hazard ratio and risk difference with 95% CIs measured the association. The UK Gout Society helped prioritize the research question. 

The results showed that of 111,460 eligible patients, 99,800 were included. Among them, 25,511 (25.6%) were female, 74,289 (74.4%) were male, and 84,928 (85.1%) were White, with a mean age of 62.8 years (SD 15.5). Prior cardiovascular events were recorded in 4,063 (4.1%), and 16,028 (16.1%) received colchicine prophylaxis. Cardiovascular event rates were lower in patients with colchicine prophylaxis (28.8 per 1000 person-years, 95% CI 25.2–33.2) than in those without (35.3 per 1000 person-years, 95% CI 33.0–37.9). The weighted rate difference was –6.5 (95% CI –9.4 to –3.6) per 1000 person-years, and the weighted hazard ratio was 0.82 (95% CI 0.69–0.94). Findings were consistent across analyses. 

Investigators found a lower risk of cardiovascular events in patients with gout prescribed colchicine prophylaxis. These findings supported the use of colchicine for gout flare prophylaxis. 

Source: thelancet.com/journals/lanrhe/article/PIIS2665-9913(24)00248-0/fulltext