Tag: gout

Categories : Cardiovascular DiseaseTags : Leave a comment

Low-dose Colchicine May Reduce Risk of Heart Attack and Stroke

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Researchers found that low-dose colchicine can be used to reduce heart attacks and strokes in high-risk patients

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A widely-used, inexpensive gout drug could reduce heart attacks and strokes in people with cardiovascular disease, according to a new Cochrane review.

The review examined the effects of low doses of colchicine, a drug used to treat gout, and found no increase in serious side effects.

Cardiovascular disease is often driven by chronic low-grade inflammation, which contributes to recurrent cardiovascular events such as heart attacks and strokes. Colchicine has anti-inflammatory properties that make it a promising option for people with heart disease. 

A promising effect on cardiovascular risk

The review included 12 randomised controlled trials involving nearly 23 000 people with a history of heart disease, heart attack or stroke. The studies looked at patients who took colchicine for at least six months, with doses of 0.5mg once or twice a day. Most participants were male (~80%) and the mean age was 57 to 74 years old. Half received colchicine, while the other half received either a placebo or no additional treatment alongside their usual care.

Overall, those taking low-dose colchicine were less likely to experience a heart attack or stroke. For every 1000 people treated, there were 9 fewer heart attacks and 8 fewer strokes compared with those not taking the drug. Whilst there were no serious adverse events identified, patients who took colchicine were more likely to have stomach or digestive side effects, but these were usually mild and didn’t last long.

Among 200 people with cardiovascular disease – where we would normally expect around seven heart attacks and four strokes – using low-dose colchicine could prevent about two of each. Reductions like this can make a real difference for patients who live with ongoing, lifelong cardiovascular risk.

– Dr Ramin Ebrahimi, co-lead author from the University Medicine Greifswald, Germany

A new use for a long-established medicine

As cardiovascular diseases are the leading cause of death globally, colchicine presents a promising inexpensive and accessible option for secondary prevention in high-risk patients.

These results come from publicly funded trials repurposing a very old, low-cost drug for an entirely new use. It shows the power of academic research to reveal treatment opportunities that traditional drug development often overlooks.

 – Lars Hemkens, senior author from the University of Bern, Switzerland

The evidence is less clear when it comes to whether colchicine affects overall death rates or the need for procedures like coronary revascularisation. The studies didn’t provide any information to say whether the drug improves quality of life or reduces hospital stays. The authors stress that further research is needed in these areas.

Source: Cochrane

Categories : Metabolic DisordersTags :

Metabolic Syndrome Increases Gout Risk Nearly Four-fold

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In a population-based study published in Arthritis & Rheumatology, researchers found that men with metabolic syndrome (MetS) and those who developed MetS – especially those with the MetS components of elevated triglycerides and abdominal obesity – were at higher risk of developing gout.

Gout is one of the most common causes of chronic inflammatory arthritis, characterised by monosodium urate (MSU) monohydrate crystals deposition in the tissues. 

Dietary sources that can contribute to hyperuricemia and gout include the consumption of animal food such as seafood (eg, shrimp, lobster), organs (eg, liver and kidney), and red meat (pork, beef). Some drinks like alcohol and sweetened drinks may also contribute to this disease. Epidemiological studies reported an increased disease burden of gout, which is largely explained by lifestyle changes like increased protein consumption and a sedentary lifestyle. 

The study included nearly 1.3 million men aged 20–39 years who participated in three serial health check-ups at two-year intervals. Among these participants, 18 473 developed gout, and those with MetS at all checkups had a nearly four-fold higher risk than participants who were MetS-free. Development of MetS more than doubled the risk of incident gout. Conversely, recovery from MetS reduced incident gout risk by nearly half.

Among MetS components, changes in elevated triglycerides and abdominal obesity displayed the greatest association with altered risk of incident gout. Age was also a factor: associations among MetS changes and incident gout were more pronounced in subjects in their 20s than subjects in their 30s and in subjects who were under- or normal weight.

“This is the first large-scale study to explore the association between dynamic changes in MetS and risk of gout,” said co–corresponding author Jaejoon Lee, MD, PhD of the Sungkyunkwan University School of Medicine, in South Korea. “Prevention and recovery from MetS can significantly lower the risk of gout in young adults.”

Source: Wiley

Categories : Cardiovascular DiseaseTags :

Gout Flare-ups Linked to Increased MI and Stroke Risk

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The risk of myocardial infarction (MI) and strokes temporarily increases in the four months after a gout flare, suggests a study published in the journal JAMA.

The findings showed that gout patients who suffered from an MI or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the 61-120 days prior.

Gout is a common form of arthritis that is caused by high levels of uric acid, a chemical produced by breakdown of body tissues and present in certain foods and drinks.

At high levels, uric acid is deposited in and around joints as needle shaped urate crystals. Once released from their deposits, these crystals cause severe inflammation that manifest as joint pain, swelling, redness, and tenderness that often lasts for 1–2 weeks. These episodes, called gout flares, often recur. Inflammation is also a risk factor for heart attack and stroke.

While gout patients tend to have more cardiovascular risk factors, there have been no previous studies about whether gout flares are linked with an increased risk of MI and stroke.

To address this, the team used data from 62 574 patients with gout treated in the NHS. Of these, 10 475 experienced heart attack or stroke after the diagnosis of gout, while matched controls did not experience such events. They evaluated the association between heart attacks or strokes and recent gout flares and adjusted these results for possible confounding factors. They found that gout patients who suffered an MI or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the preceding 61–120 days.

They found a similar high rate of MI or stroke in the 0–60 and 61–120 days after gout flares compared with other time periods, when they used information from only patients who consulted for a gout flare and also experienced either MI or stroke. This further strengthened the finding that gout flares are associated with a transient increase in cardiovascular events following flares. The increased odds and rates persisted when people with pre-existing heart disease or stroke before their gout diagnosis were excluded, and when shorter exposure periods such as 0-15 and 16-30 days prior to MI or stroke, were considered.

Gout patients who died from a MI or stroke had over four times the odds of experiencing a gout flare in the preceding 0-60 days and over twice the odds of gout flare in the preceding 61-120 days.

The study’s lead author, Professor Abhishek at the University of Nottingham, said: “This is the first study of its kind to examine whether there is an association between recent gout flares and heart attacks and strokes.

“The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares.

“People with recurrent gout flares should be considered for long-term treatment with urate lowering treatments such as allopurinol. This is a reliable way of removing urate crystal deposits and providing freedom from gout flares. Patients should also be considered for concurrent treatment with anti-inflammatory medicines such as colchicine for the first few months because urate lowering treatments may trigger gout flares in the short term.

“People with gout should be encouraged to adopt a healthy lifestyle with appropriate treatment of conditions such as high blood pressure, high cholesterol, obesity and diabetes to minimise their background risk of heart attack and stroke.”

Source: University of Nottingham

Categories : Diseases, Syndromes and ConditionsTags :

Low Doses of Benzbromarone may be Better for Gout Treatment

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A painful inflammatory form of arthritis, gout is characterised by urate crystals accumulating in joints, soft tissue and bones. To decrease blood urate levels in patients and reduce flareups, the standard treatment is xanthine oxidase inhibitors such as febuxostat. But new research published in Arthritis & Rheumatology has found a possible better option in the form of low doses of benzbromarone, a less commonly used drug.

Biochemically, gout is characterised by extracellular fluid urate saturation, which is reflected by hyperuricaemia in the blood, with plasma or serum urate concentrations in excess of 6.8 mg/dL; this is the approximate limit of urate solubility.

Benzbromarone is a uricosuric drug that has been used in the treatment of gout over the last 30 years. It reduces the urate reabsorption, diminishing serum urate levels and therefore preventing gout flares.

In this prospective single-centre, open-labelled trial, 196 men with gout and low urinary excretion of uric acid were randomised to receiving either low-dose benzbromarone (LDBen) or low-dose febuxostat (LDFeb) for 12 weeks.

More participants in the LDBen group achieved the blood urate target of < 6 mg/dL than those in the LDFeb group (61% versus 32%). There was little difference in side effects between the groups.

The authors concluded that, “The results suggest that low dosing of benzbromarone may warrant stronger consideration as a safe and effective therapy to achieve serum urate target in gout.”

Source: Wiley