Association between colchicine use and adverse cardiovascular events in patients with gout: a nationwide nested case-control study

Objective: The association between colchicine use and the primary prevention of atherosclerotic cardiovascular disease (ASCVD) remains unknown. This study aimed to explore the association between colchicine use and new development of ASCVD and ASCVD-related mortality in patients with incident gout. Methods: This nested case-control study utilized the nationwide claims database of the Korean National Health Insurance System. Patients without a history of ASCVD who developed incident gout and were newly started on allopurinol as first-line therapy between 2011 and 2016 were initially screened. Individuals who experienced ASCVD event or ASCVD-related mortality during the follow-up period were matched with four controls for age, sex, income, residential area, co-morbidities and medications. The main exposure was colchicine use, assessed by (i) the cumulative defined daily doses (cDDDs) and (ii) the cumulative duration. For secondary analyses, the risk of ASCVD events and ASCVD-related mortality were examined separately. Results: Overall, 9346 patients with ASCVD event or ASCVD-related mortality were matched with 35070 controls. The patient population was predominantly male. Compared with non-users, a curvilinear relationship between higher cDDDs of colchicine and the odds of ASCVD event was observed; the odds ratios (95% CI) were 1.09 (1.04, 1.15) for <90 cDDDs, 1.20 (1.07, 1.33) for 80-179 cDDDs and 1.21 (1.09, 1.35) for >= 180 cDDDs. This association was similarly observed for ASCVD events and ASCVD-related mortality. Conclusion: Colchicine use was associated with an increased risk of ASCVD in patients with newly diagnosed gout who did not have a prior history of ASCVD.