Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA.
Department of Internal Medicine, University of Connecticut, Hartford, CT, USA.
Am J Cardiovasc Drugs. 2021 Sep;21(5):499-512. doi: 10.1007/s40256-020-00459-1. Epub 2020 Dec 28.
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.
高尿酸血症和痛风与心血管（CV）疾病、中风、高血压、心力衰竭和慢性肾脏病的风险增加有关，其可能通过促炎环境起作用。然而，并非所有用于痛风治疗的药物都能改善 CV 结局；秋水仙碱在近期心肌梗死和稳定型冠状动脉疾病患者中的 CV 结局得到改善，且独立于降脂作用。在 COLCOT、LoDoCo、LoDoCo2、LoDoCo-MI 试验和 COLCORONA 试验发表后，人们对秋水仙碱再次产生兴趣，这些试验将阐明其在 COVID-19 中的作用。我们的目的是在探讨秋水仙碱在心脏疾病之外的 CV 用途，以及现有的痛风治疗方法（包括别嘌醇和非布司他）的 CV 结局。本文讨论了 CARES 试验及其引发的争议，这导致美国 FDA 对非布司他发出“黑框”警告，以及最近的 FAST 试验与之相悖，发现非布司他非劣效。
