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Gout Pharmacotherapy in Cardiovascular Diseases: A Review of Utility and Outcomes

Author

Am J Cardiovasc Drugs. 2020 Dec 28;1-14. doi: 10.1007/s40256-020-00459-1.Online ahead of print.

Subuhi Kaul 1Manasvi Gupta 2Dhrubajyoti Bandyopadhyay 3Adrija Hajra 4Prakash Deedwania 5Edward Roddy 6Mamas Mamas 7Allan Klein 8Carl J Lavie 9Gregg C Fonarow 10Raktim K Ghosh 11

Author Information

1 Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA.

2 Department of Internal Medicine, University of Connecticut, Hartford, CT, USA.

3 Department of Internal Medicine, Mount Sinai St Luke's Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

4 Department of Internal Medicine, Albert Einstein College of Medicine, New York, NY, USA.

5 UCSF School of Medicine, Fresno, CA, USA.

6 School of Primary, Community and Social Care, Primary Care Centre Versus Arthritis, Keele University, Stafford, UK.

7 Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Staffordshire, UK.

8 Department of Cardiovascular Medicine, Center for Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.

9 John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA.

10 Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.

11 MedStar Heart and Vascular Institute, Union Memorial Hospital, Baltimore, MD, USA. raktimghoshmd@gmail.com.

Abstract

Hyperuricemia and gout have been linked to an increased risk for cardiovascular (CV) disease, stroke, hypertension, heart failure, and chronic kidney disease, possibly through a proinflammatory milieu. However, not all the drugs used in gout treatment improve CV outcomes; colchicine has shown improved CV outcomes in patients with recent myocardial infarction and stable coronary artery disease independent of lipid-lowering effects. There is resurging interest in colchicine following publication of the COLCOT, LoDoCo, LoDoCo2, LoDoCo-MI trials, and COLCORONA trial which will shed light on its utility in COVID-19. Our aim is to review the CV use of colchicine beyond pericardial diseases, as well as CV outcomes of the available gout therapies, including allopurinol and febuxostat. The CARES trial and its surrounding controversies, which lead to the US FDA 'black box' warning on febuxostat, in addition to the recent FAST trial which contradicts this and finds febuxostat to be non-inferior, are discussed in this paper.