People with gout have higher cardiovascular disease risk and gout flares have been associated with a short-term increase in acute cardiovascular events. Long-term treat-to-target urate-lowering therapy (T2T-ULT) prevents gout flares. Whether lowering serum urate with T2T-ULT will prevent cardiovascular events, likely via flares reduction, has not been investigated. Additionally, whether gout flares are associated with arrhythmias, decompensated heart failure, and complications of acute myocardial infarction is unknown. The purpose of this study is to better understand cardiovascular outcomes associated with gout flares and to ascertain if T2T-ULT and colchicine flare prophylaxis prevent cardiovascular events.
Project LeadDr. Edoardo Cipolletta
This fellowship will answer three unresolved questions in the field of gout:
Question 1: Does T2T-ULT that meets serum urate target prevent cardiovascular events? Hypothesis: In gout patients commenced on ULT, those that achieved serum urate treatment target <360 μmol/L will be less likely to experience cardiovascular events.
Question 2: Does colchicine flare prophylaxis with ULT prevent cardiovascular events? Hypothesis: In gout patients commenced on ULT, co-prescription of colchicine flare prophylaxis will associate negatively with cardiovascular events.
Question 3: Are gout flares associated with cardiac arrhythmias, decompensated heart failure, and complications of acute myocardial infarction? Hypothesis: Recent prior gout flares will be associated with cardiac arrhythmias, decompensated heart failure, and complications of acute myocardial infarction.
This project will be delivered in three work packages (WP) using two national registration databases in the UK, and Sweden.
WP1 will be completed during year 1, WP2 during year 2 and WP3 during year 3.
For each WP, a tentative timeline will be as follows:
- Months 1-8: data extraction, cohort development, case/control matching, data cleaning, coding and analysis
- Months 8-10: manuscript drafting
- Months 11-12: dissemination of the results
Finally, a 3-year Master in Epidemiology at the London School of Hygiene and Tropical Medicine will be carried out throughout the fellowship.
Gout Society and people with gout from Italy have advised on the research questions. They will co-develop the lay summary of results for the patient community and help disseminate findings including at Scientific meetings