Colchicine Use and Incident Coronary Artery Disease in Male Patients with Gout.,Canadian Journal of Cardiology

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Colchicine Use and Incident Coronary Artery Disease in Male Patients with Gout.
Canadian Journal of Cardiology ( IF 5.8 ) Pub Date : 2020-05-23 , DOI: 10.1016/j.cjca.2020.05.026
Binita Shah ₁ , Michael Toprover ₂ , Daria B Crittenden ₂ , Susanna Jeurling ₃ , V Courtney Pike ₄ , Svetlana Krasnokutsky ₂ , Yuhe Xia ₅ , Mark C Fisher ₆ , Anastasia Slobodnick ₂ , Craig T Tenner ₇ , Stuart D Katz ₈ , Michael H Pillinger ₂

Affiliation

Section of Cardiology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA; Division of Cardiology, Department of Medicine, NYU School of Medicine/NYU Langone Health, New York, New York, USA.
Section of Rheumatology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA; Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Langone Health, New York, New York, USA.
Section of Rheumatology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA; Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Langone Health, New York, New York, USA; Division of Rheumatology, Department of Medicine, John Hopkins Medical Center, Baltimore, Maryland, USA.
Section of Rheumatology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA.
Division of Biostatistics, Department of Population Health, NYU School of Medicine/NYU Langone Health, New York, New York, USA.
Section of Rheumatology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA; Division of Rheumatology, Department of Medicine, NYU School of Medicine/NYU Langone Health, New York, New York, USA; Division of Rheumatology, Department of Medicine, PrimaCare, Fall River, Massachusetts, USA.
Section of General Internal Medicine, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA; Division of General Internal Medicine, Department of Medicine, NYU School of Medicine/NYU Langone Health, New York, New York, USA.
Section of Cardiology, Department of Medicine, VA New York Harbor Health Care System, New York, New York, USA.

Background

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.

Methods

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.

Results

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).

Conclusions

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.

中文翻译：

男性痛风患者中秋水仙碱的使用和发生冠状动脉疾病。

背景

炎症与冠状动脉疾病 (CAD) 和心肌梗塞 (MI) 相关。痛风患者发生 MI 的风险增加，而秋水仙碱与 MI 风险降低有关。本研究的目的是确定秋水仙碱是否能防止痛风患者发生 CAD。

方法

这项回顾性研究跟踪了 VA 纽约港医疗保健系统诊断出痛风时没有已知 CAD 的一组男性痛风患者。秋水仙碱的使用与 CAD 发生之间的关联，定义为负荷试验或血管造影时缺血或阻塞性 CAD 的证据，使用逆概率加权 (IPW) Cox 比例风险模型确定。

结果

在 178,877 名患者中，1638 名符合痛风标准，其中 722 名在基线时没有已知的 CAD（446 名秋水仙碱使用者和 276 名未使用者）中位随访时间为 96 个月（57 至 117 个月）。观察到秋水仙碱的使用与降低的 CAD 发生率之间存在关联的趋势，但没有统计学意义（IPW 风险比 [HR]，0.49；0.23-1.05）。在没有慢性肾病的患者中，秋水仙碱的使用与较低的 CAD 发生率相关（相互作用P = 0.005，IPW HR，0.31；0.14-0.70）。秋水仙碱还与较低的 CAD 和 MI 复合发生率相关（IPW HR，0.37；0.16-0.83）。