Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Gout with and without coronary artery disease (n=10026). Intervention: Colchicine vs. No colchicine treatment. Primary outcome: Myocardial infarction (MI) (RR 0.71, 95% CI 0.36-1.39).

Q: What does this research mean for the field?

Colchicine treatment in patients with gout does not significantly reduce the risk of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting, but is associated with reduced all-cause mortality. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muhammad Umer Siddiqui; Joey Junarta; Swaminathan Sathyanarayanan; Kirpal Kochar; Waqas Ullah; David L. Fischman

doi:10.1016/j.ijcha.2023.101191

March 4, 2023IJC Heart & VasculatureOpen Access

Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis

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Key result

Colchicine treatment in patients with gout did not reduce the risk of myocardial infarction, PCI, or CABG compared to no colchicine.

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Why the study?

Colchicine has anti-inflammatory properties, but its utility in improving cardiovascular outcomes in patients with gout with and without CAD has been disputed.

Does colchicine reduce the risk of myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting in patients with gout?

Key Points

To evaluate the impact of colchicine on cardiovascular outcomes and all-cause mortality in patients with gout.
Systematic search of Medline, Web of Science, and Cochrane Central Register of Controlled Trials.
Included 4 observational studies comprising 10,026 patients with gout, comparing 6,800 patients treated with colchicine to 3,426 patients not receiving colchicine.
There was no significant difference between colchicine and non-colchicine groups in myocardial infarction (RR 0.71; 95% CI, 0.36–1.39), percutaneous coronary intervention (RR 0.83; 95% CI, 0.53–1.29), coronary artery bypass grafting (RR 1.98; 95% CI, 0.70–5.58), or stroke (RR 0.51; 95% CI, 0.15–1.78).

Study Design

Type

Meta-Analysis (n=10,026)

Structured PICO

Does colchicine reduce the risk of myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting in patients with gout?

P

Population

10,026 patients with gout (mean age 69.3 years) across 4 observational studies comparing colchicine users (n=6,800) with non-users (n=3,426).

E

Exposure

Colchicine (dosage not specified in the included studies; concurrent treatments in individual studies included allopurinol or xanthine oxidase inhibitors)

C

Comparator

No colchicine treatment (patients with gout not receiving colchicine; concurrent treatments included allopurinol or xanthine oxidase inhibitors)

O

Outcome

Myocardial infarction (MI), need for percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)hard clinical

Main Result

Relative Risk: 0.71 (95% CI 0.36–1.39)

In observational studies of patients with gout, colchicine therapy was not associated with an overall reduction in myocardial infarction, stroke, or coronary revascularization, though it was associated with lower all-cause mortality and lower MI risk in the subgroup of studies including patients with baseline CAD.

Limitations

Two included studies did not include females, limiting generalizability.
All included studies were observational in design and lacked randomization, increasing the risk of selection bias and confounding.
High heterogeneity among included studies regarding population studied, outcomes reported, and concomitant gout medications.
No mention of the dosage of colchicine used in the included studies.
Two included studies did not include females, limiting generalizability
All included studies were observational and lacked randomization and blinding, resulting in high risk of selection and confounding bias
Significant heterogeneity in populations studied, outcomes reported, and concomitant gout medications
No mention of the dosage of colchicine used in the included studies
Unable to statistically evaluate publication bias due to the small number of included studies (n=4)

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Colchicine should not yet inform coronary prevention strategies in gout; leaves open a mortality benefit for prospective randomized testing.

Abstract

Background: Colchicine has anti-inflammatory properties, but its utility in improving cardiovascular outcomes has been disputed. Here, we study the impact of colchicine on cardiovascular outcomes in patients with gout with and without coronary artery disease (CAD). Methods: Medline, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Primary outcomes included myocardial infarction (MI), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Secondary outcomes included stroke and all-cause mortality. Results: We included 4 observational studies comprising 10,026 patients with gout on treatment with colchicine. There was no significant difference in the risk of myocardial infarction (risk ratio [RR] 0.71; 95% confidence interval [CI], 0.36-1.39), need for PCI, or need for CABG, between patients on colchicine and those not receiving colchicine. Colchicine was associated with a significantly lower risk of all-cause mortality (RR 0.58; 95% CI 0.43-0.79). Conclusion: Non-randomized studies suggest that risk of MI, stroke and revascularization is not higher in gout patients treated with colchicine compared to gout patients without colchicine treatment.

Discussion

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Cite This Study

Siddiqui et al. (2023) conducted a meta-analysis in Gout with and without coronary artery disease (n=10,026). Colchicine vs. No colchicine treatment was evaluated on Myocardial infarction (MI) (RR 0.71, 95% CI 0.36-1.39). Colchicine treatment in patients with gout did not reduce the risk of myocardial infarction, PCI, or CABG compared to no colchicine.

synapsesocial.com/papers/6a775f53cb17b32ad6bd6e0c https://doi.org/10.1016/j.ijcha.2023.101191

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Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Risk of coronary artery disease in patients with gout on treatment with Colchicine: A systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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