Gout linked to increased cardiovascular disease risk
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ATLANTA — Gout is associated with an increased risk for cardiovascular disease, as calculated via population-level cardiovascular risk equations, according to data presented at ACR/ARP 2019.
“Some studies have reported that gout and hyperuricemia are independent risk factors for cardiovascular disease events,” Ken Cai, MBBS, MSc, of the University of Auckland, in New Zealand, told attendees. “In New Zealand, gout affects more than 4% of the adult population. Maori and Pasifika people are disproportionately affected by gout — 8.5% of Maori and 13.9% of Pasifika adults. One-third of Maori and Pasifika adults over the age of 65 years have gout.”
To evaluate the link between gout and estimated population-level risk for cardiovascular disease, as well as cardiovascular disease outcomes, Cai and colleagues linked national registries of medication dispensing data, hospitalization and death to the Auckland/Northland regional repository of laboratory results. Focusing on the period from Jan. 1, 2012, to Dec. 31, 2016, the researchers formed the study cohort from 968,986 individuals with no cardiovascular disease prior to that time.
Cai and colleagues determined sex-specific baseline 5-year risk for cardiovascular disease — including cardiovascular-related death, nonfatal myocardial infarction, stroke and other events — using the published population-level risk scores. To identify individuals with gout, the researchers used a definition that included a discharge diagnosis from a public hospital admission, or having been given disease-specific medications. Of the individuals included in the cohort, 32,805 had gout. Data were limited to individuals aged 20 years and older who had maintained a primary residence in the Auckland/Northland region for the past 3 years.
According to the researchers, the population-level, estimated 5-year risk for cardiovascular disease, as well as the rates of fatal and nonfatal cardiovascular events, were higher among women and men with gout. After adjusting for age, gender, ethnicity, deprivation quintile and population-level estimated 5-year risk, gout was independently associated with an increased likelihood of both fatal (adjusted OR = 1.37; 95% CI, 1.27-1.48) and nonfatal (aOR = 1.41; 95% CI, 1.35-1.47) cardiovascular events.
In addition, compared with individuals without gout, there was no statistically significant difference in risk for cardiovascular disease events among those with gout who received allopurinol compared with those who did not. There was also no statistically significant difference in adjusted odds ratio for those with serum urate above 6mg/dL or below 6mg/dL, compared with people without gout.
“Gout is associated with an increased estimated risk for cardiovascular disease events calculated from population-level cardiovascular risk equations,” Cai said. “Even after adjustment for estimated 5-year cardiovascular disease risk, and additional weighting of risk factors within it, gout independently increased the hazard ratio for fatal and non-fatal events. This effect was not ameliorated by allopurinol use or serum urate lowering to treatment targets.” – by Jason Laday
Reference:
Cai K. The relationship between gout and cardiovascular disease outcomes: A health data linkage study of 1 million New Zealanders using population-level cardiovascular risk prediction equations. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Cai reports professional relationships with Arthritis Australia.