Colchicine use was associated with reduced all-cause mortality in patients with diabetic gout without prior coronary artery disease: A propensity-matched nationwide cohort study

Colchicine has been associated with reduced cardiovascular events in secondary prevention, but evidence for primary prevention is limited. We examined the association between colchicine use and cardiovascular outcomes in patients with type 2 diabetes mellitus and gout without prior coronary artery disease. From the Korean National Health Insurance Service database, we identified 48,295 patients with diabetes and gout without prior coronary artery disease between 2015 and 2019. We compared 28,964 colchicine users with 19,331 non-users by 1:1 propensity score matching, which produced 17,337 matched pairs. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. The primary composite outcome occurred in 12.52% of colchicine users versus 15.03% of non-users (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.66-0.75; P < 0.001). All-cause mortality was significantly reduced in colchicine users (8.01% vs. 11.07%; HR 0.58; 95% CI 0.53-0.62; P < 0.001). No significant differences were observed for myocardial infarction (HR 1.15; 95% CI 0.96-1.37; P = 0.121) or stroke (HR 0.91; 95% CI 0.81-1.01; P = 0.076). In a landmark analysis at 365 days that addressed immortal time bias, the associations with all-cause mortality (HR 0.67; 95% CI 0.62-0.73; P < 0.001) and with the composite outcome (HR 0.76; 95% CI 0.71-0.81; P < 0.001) remained significant, whereas stroke (HR 0.99; 95% CI 0.87-1.12; P = 0.823) and myocardial infarction (HR 1.15; 95% CI 0.95-1.40; P = 0.144) did not differ between the two groups. In patients with diabetes and gout without prior coronary artery disease, colchicine use was associated with lower all-cause mortality. The reduction in the composite outcome was driven by mortality rather than by myocardial infarction or stroke.