Colchicine Use and Incident Coronary Artery Disease in Male Patients With Gout

• Published in: Canadian journal of cardiology 2020-11, Vol.36 (11), p.1722-1728
• Main Authors: Shah, Binita, Toprover, Michael, Crittenden, Daria B., Jeurling, Susanna, Pike, V. Courtney, Krasnokutsky, Svetlana, Xia, Yuhe, Fisher, Mark C., Slobodnick, Anastasia, Tenner, Craig T., Katz, Stuart D., Pillinger, Michael H.
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.05.026

Inflammation is associated with coronary artery disease (CAD) and myocardial infarction (MI). Patients with gout are at increased risk of MI, and colchicine is associated with a reduced risk of MI. The objective of this study was to determine whether colchicine prevents incident development of CAD in patients with gout. This retrospective study followed a cohort of male patients with gout without known CAD at the time of diagnosis of gout in the VA New York Harbor Healthcare System. The association between colchicine use and development of incident CAD, defined as evidence of ischemia or obstructive CAD on stress test or angiography, was determined using an inverse probability weighted (IPW) Cox proportional hazard model. Among 178,877 patients, 1638 met criteria of gout, of whom 722 without known CAD at baseline (446 colchicine users and 276 nonusers) were followed for a median of 96 months (57 to 117). A trend toward association between use of colchicine and reduced incident CAD was observed but not statistically significant (IPW hazard ratio [HR], 0.49; 0.23-1.05). In patients without chronic kidney disease, use of colchicine was associated with a lower rate of incident CAD (interaction P = 0.005, IPW HR, 0.31; 0.14-0.70). Colchicine was also associated with a lower rate of the composite of incident CAD and MI (IPW HR, 0.37; 0.16-0.83). In male patients with gout and no known CAD, a trend of reduced incident CAD was observed with use of colchicine that was not statistically significant. Larger, prospective studies will be required to assess the primary prevention benefit of colchicine definitively. L’inflammation est associée à la coronaropathie et à l’infarctus du myocarde (IM). Les patients atteints de la goutte sont exposés à un risque accru d’IM. Néanmoins, la colchicine est associée à la diminution de ce risque d’IM. L’objectif de la présente étude était de déterminer si la colchicine prévient l’incidence de la coronaropathie chez les patients atteints de goutte. Cette étude rétrospective portait sur le suivi d’une cohorte de patients de sexe masculin atteints de goutte, mais sans coronaropathie connue au moment du diagnostic de la goutte, du VA New York Harbor Healthcare System. L’association entre l’utilisation de la colchicine et l’incidence de la coronaropathie, définie par les signes d’ischémie ou de coronaropathie obstructive à l’épreuve d’effort ou à l’angiographie, était déterminée à l’aide du modèle à risques proportionnels de Cox pondéré