Pos0001 Risk of Cardiovascular Events After First Gout Flare Consultation in Primary Care: A Self-Controlled Case Series Analysis Using Uk Primary Care, Hospitalisation, and Mortality Data

Background: Gout flares have been associated with short-term increased risk of cardiovascular events [1,2]. However, it is not known if this association holds in patients with gout experiencing their first flare. Objectives: To investigate whether the first consultation for gout flare was temporally associated with a short-term increase in the risk of cardiovascular events. Methods: Study design. Self-controlled case series (SCCS) analyses adjusted for age in years and season. Population. Patients with a new diagnosis of gout registered in CPRD Gold between 01/01/1997 and 31/12/2020 who consulted for a gout flare as the first primary-care consultation for gout and who had a cardiovascular event in the study period of up to 2 years after or before the first consultation for gout. To minimise the risk of including prevalent gout cases, we considered subjects with a new diagnosis of gout at least 2 years after the patient's registration at the current general practice, without hospitalization for gout, prescriptions of urate-lowering therapy (ULT), or mention of codes indicating prevalent gout (i.e., history of gout) before or on the first consultation for gout flare in primary care. Exposure. First gout flare consultation was defined using gout diagnosis and flare treatment on the same date [1]. Outcomes. Primary: cardiovascular events (fatal and non-fatal ischaemic or haemorrhagic stroke or myocardial infarction) during the SCCS study period. Secondary: first-ever cardiovascular events, cardiovascular events leading to death or requiring hospitalisation, myocardial infarction, and stroke. Statistical analysis. The observation time was split into an exposed period (120 days after the first consultation for gout divided into three parts: 0-30, 31-60, and 61-120 days) and a baseline period (up to 730 days before and after the first gout consultation). The association between gout flare and cardiovascular events was measured using adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (95%CIs). Sensitivity analyses were carried out to test the robustness of the association between the exposure and the outcome. Results: Among 77,440 patients with a new diagnosis of gout who met our inclusion criteria, 1,870 patients were included in the SCCS study (Figure 1). Their mean (SD) age was 75.2 (11.0) years, 609 (32.4%) were female, 1,609 (86.0%) patients had a high or very high cardiovascular risk, and 627 (33.5%) had a prior history of acute coronary syndromes, cerebrovascular diseases, or transient ischaemic attacks. 147 (7.9%) had a prescription for anti-inflammatory medications (NSAIDs, colchicine, or corticosteroids) in the previous 60 days. The incidence of cardiovascular events was higher in the 30 days after the first consultation for gout flare than in the baseline period with a crude rate difference of 0.38 events/1,000 person-days (95%CI: 0.09-0.66) and an aIRR of 1.40 (95% CI 1.09-1.80). The aIRR of cardiovascular events during the first 15 days after the first gout flare was 1.52 (95% CI 1.10-2.11) relative to the baseline period (crude rate difference of 0.48 events/1,000 person-days (95%CI: 0.08-0.89). Results were consistent in sensitivity analyses (Figure 2). Conclusion: First gout flare consultation is associated with cardiovascular events. Whilst these patients were a group with a first diagnosis of gout at older age and with high cardiovascular risk, findings support the use of ULT and flare prophylaxis offered from the first gout presentation. REFERENCES: [1] doi:10.1001/jama.2022.11390. [2] doi:10.1002/acr2.11540. Acknowledgements: This project has been funded by the Foundation for Research in Rheumatology (FOREUM). Disclosure of Interests: Edoardo Cipolletta has received consulting fees from Horizon Therapeutics and lecturing fees from Novartis outside the submitted work., Georgina Nakafero: None declared, Pascal Richette: None declared, Anthony Avery: None declared, Mamas Mamas: None declared, Laila Tata: None declared, Abhishek Abhishek: None declared.