Pitavastatin use and reduced risk of gout: a nationwide propensity score-matched cohort study

Statins are widely prescribed for lipid management and cardiovascular prevention, but their effects on gout risk remain unclear. Pitavastatin has distinct metabolic and anti-inflammatory properties, including upregulation of adiponectin and preservation of glucose transporter-4 expression, which may improve insulin sensitivity and modulate inflammatory pathways. This study aimed to evaluate whether pitavastatin use is associated with a reduced risk of gout compared with other statins.

We conducted a retrospective cohort study using data from the Taiwan Longitudinal Generation Tracking Database 2005 of the National Health Insurance program. Patients aged ≥ 18 years who initiated pitavastatin or other statins between 2014 and 2021 were included. Those with prior gout or statin use before 2014 were excluded. After 1:4 propensity score matching for age, sex, comorbidities, and concomitant medications, 12,581 pitavastatin users and 50,324 users of other statins were analyzed. Gout incidence was compared using Kaplan-Meier analysis and Cox proportional hazards models.

During a mean follow-up of 3.1 years, 380 gout cases occurred among pitavastatin users (9.83 per 1000 person-years) and 2370 among other statin users (15.22 per 1000 person-years). Pitavastatin use was associated with a significantly lower risk of gout (adjusted hazard ratio, 0.64; 95% confidence interval, 0.58-0.72). The association with a lower risk remained consistent after stratification by sex and age and was most pronounced in patients with diabetes mellitus (aHR 0.53) and chronic liver disease (aHR 0.50).

Pitavastatin use was associated with a lower risk of incident gout compared with other statins in this nationwide cohort. Further prospective and mechanistic studies are needed to confirm these findings.