Mouradjian Mallory T, Plazak Michael E, Gale Stormi E, Noel Zachary R, Watson Kristin, Devabhakthuni Sandeep
Department of Pharmacy, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA.
Am J Cardiovasc Drugs. 2020 Oct;20(5):431-445. doi: 10.1007/s40256-020-00400-6.
Gout is the most common inflammatory arthritis and is often comorbid with cardiovascular disease (CVD). Hyperuricemia and gout are also independent risk factors for cardiovascular events, worsening heart failure (HF), and death. The recommended treatment modalities for gout have important implications for patients with CVD because of varying degrees of cardiovascular and HF benefit and risk. Therefore, it is critical to both manage hyperuricemia with urate-lowering therapy (ULT) and treat acute gout flares while minimizing the risk of adverse cardiovascular events. In this review, the evidence for the safety of pharmacologic treatment of acute and chronic gout in patients with CVD and/or HF is reviewed. In patients with CVD or HF who present with an acute gout flare, colchicine is considered safe and potentially reduces the risk of myocardial infarction. If patients cannot tolerate colchicine, short durations of low-dose glucocorticoids are efficacious and may be safe. Nonsteroidal anti-inflammatory drugs should be avoided in patients with CVD or HF. The use of canakinumab and anakinra for acute gout flares is limited by the high cost, risk of serious infection, and relatively modest clinical benefit. For long-term ULT, allopurinol, and alternatively probenecid, should be considered first-line treatments in patients with CVD or HF given their safety and potential for reducing cardiovascular outcomes. An increased risk of cardiovascular death and HF hospitalization limit the use of febuxostat and pegloticase as ULT in this population. Ultimately, the selection of agents used for acute gout management and long-term ULT should be individualized according to patient and agent cardiovascular risk factors.
痛风是最常见的炎性关节炎，常与心血管疾病（CVD）合并存在。高尿酸血症和痛风也是心血管事件、心力衰竭（HF）恶化及死亡的独立危险因素。由于痛风的推荐治疗方式对心血管和HF的益处及风险程度不同，因此对CVD患者具有重要意义。所以，在使用降尿酸治疗（ULT）控制高尿酸血症并治疗急性痛风发作的同时，将不良心血管事件风险降至最低至关重要。在本综述中，我们回顾了CVD和/或HF患者急性和慢性痛风药物治疗安全性的证据。对于出现急性痛风发作的CVD或HF患者，秋水仙碱被认为是安全的，且可能降低心肌梗死风险。如果患者不能耐受秋水仙碱，短期低剂量糖皮质激素有效且可能安全。CVD或HF患者应避免使用非甾体抗炎药。卡那单抗和阿那白滞素用于急性痛风发作的应用受到高成本、严重感染风险及相对有限的临床获益的限制。对于长期ULT，鉴于其安全性及降低心血管结局的潜力，别嘌醇以及丙磺舒应被视为CVD或HF患者的一线治疗药物。心血管死亡和HF住院风险增加限制了非布司他和聚乙二醇化尿酸酶在该人群中作为ULT的应用。最终，急性痛风管理和长期ULT药物的选择应根据患者及药物的心血管危险因素进行个体化。
