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Urate-Lowering Therapy May Prevent the Development of Coronary Artery Disease in Patients With Gout

Fu-Shun Yen1, Chih-Cheng Hsu2,3,4, Hsin-Lun Li5,6

  • 1Dr. Yen's Clinic, Taoyuan City, Taiwan.

Frontiers in Medicine
|March 17, 2020
PubMed

Insights

Urate-lowering therapy (ULT) significantly reduces the risk of coronary artery disease (CAD) and stroke in gout patients. ULT showed no effect on heart failure (HF) risk, but uricosuric agents demonstrated a dose-response benefit for CAD and stroke prevention.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pharmacology

Background:

  • Hyperuricemia is strongly linked to cardiovascular (CV) diseases.
  • Limited research exists on urate-lowering therapy (ULT) for preventing CV disease development.
  • Gout patients are at increased risk for cardiovascular events.

Purpose of the Study:

  • To compare the risks of incident coronary artery disease (CAD), stroke, and heart failure (HF) between ULT users and non-users in patients with gout.
  • To investigate the specific effects of different ULTs on cardiovascular outcomes.

Main Methods:

  • Retrospective cohort study using Taiwan's National Health Insurance Research Database (2000-2012).
  • Included 4,072 gout patients, with 2,036 ULT users and 2,036 matched non-users.
  • Compared incidence rates and calculated adjusted hazard ratios (aHR) for CAD, stroke, and HF.

Main Results:

  • ULT users showed significantly lower risks for incident CAD (aHR: 0.7) and stroke (aHR: 0.68) compared to non-users.
  • ULT had a neutral effect on the risk of incident heart failure (aHR: 0.92).
  • Uricosuric agents, a type of ULT, demonstrated significant CAD and stroke prevention, with a potential dose-response trend for CAD.

Conclusions:

  • Urate-lowering therapy is associated with reduced risks of incident coronary artery disease and stroke in patients with gout.
  • The findings support the recommendation for gout patients to utilize ULT to mitigate their cardiovascular disease burden.
  • Uricosuric agents may offer specific cardioprotective benefits.

Keywords:
coronary artery diseasegoutheart failurestrokeurate-lowering therapy

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