Gout and Cardiovascular Risk

April 16, 2018

Gregory M. Weiss, MD

Here: the latest evidence on the effects of febuxostat, allopurinol, and statins on CV mortality in patients with gout.

References1. White WB, Saag KG, Becker MA, et al; CARES Investigators. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med. 2018;378:1200-1210.2. Keller SF, Rai SK, Lu N, et al. Statin use and mortality in gout: a general population-based cohort study. Semin Arthritis Rheum. Published online: March 17, 2018. doi.org/10.1016/j.semarthrit.2018.03.007

Here I review two recent studies that shed light on what we know about gout and cardiovascular disease. The first study demonstrated that febuxostat is non-inferior to allopurinol with respect to adverse cardiovascular events but increases mortality in patients with gout. The second study showed that statin therapy lowers the risk of mortality in persons with gout.

Click through the slides for the details of these studies and the take-home messages for physicians.

(Image: ©Kateryna Kon/Shutterstock.com)

Febuxostat is a non-purine xanthine oxidase inhibitor, while allopurinol is a purine base analogue xanthine oxidase inhibitor.

Doses of allopurinol were modified according to kidney function. Febuxostat doses were not modified according to kidney function.

Additional safety end points included death from any cause, urgent cerebrovascular revascularization, transient ischemic attack, hospitalization for heart failure, arrhythmias not associated with ischemia, and venous thromboembolic events.

Sudden cardiac death was the most common cause of cardiovascular death.

Rates of hospitalization for heart failure, hospital admissions for arrhythmias not associated with ischemia, venous thromboembolic events, and hospitalization for transient ischemic attacks were similar in the two groups.

Statin initiators had a 16% lower relative rate of all-cause mortality (hazard ratio = 0.84; 95% confidence interval [CI], 0.79 to 0.89) and a rate difference of 7.7 (95% CI, 6.1 to 9.3) fewer deaths per 1000 person-years.