Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients

Jasvinder A Singh,John D Cleveland

doi:10.1186/s13075-018-1606-z

Abstract

BackgroundCurrent evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults.MethodsWe assessed the 2006–2012 Medicare 5% claims data for the association of gout at baseline with the occurrence of a new (incident) MI during follow-up (no diagnosis of MI in the baseline period of at least 1 year), adjusting for patient demographics, medical comorbidity (Charlson–Romano index), and commonly used cardiovascular and gout medications, in a Cox proportional hazards model. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.ResultsIn a cohort of 1,733,613 eligible people, 14,279 developed incident MI: 13,029 MIs in people without gout and 1250 MIs in those with gout, with crude incident rates of 1.3 vs 4.1 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was significantly associated with a higher hazard of incident MI, with HR of 2.08 (95% CI 1.95, 2.21). Risk was minimally attenuated in sensitivity analyses that replaced the continuous Charlson–Romano index score with a categorical score or individual comorbidities, or expanding to a more sensitive diagnostic algorithm for incident MI, or additionally adjusting for obesity.ConclusionsGout was independently associated with a higher risk of MI in the elderly, aged 65 years or older. The role of inflammatory and other pathways need to be explored as underlying mechanisms for this association.

Highlights

Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking
In multivariable-adjusted analyses, gout was significantly associated with higher hazard of incident MI, with Hazard ratios (HRs) of 2.08, which was minimally attenuated in sensitivity analyses that replaced the continuous Charlson–Romano score with a categorical score or individual comorbidities
Older age, male gender, white race, and higher comorbidity were each associated with a higher hazard of incident MI (Table 2)

Summary

Introduction

Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults. MI is associated with high mortality rate [4] and significant health care costs [5]. Traditional risk factors for CAD are well known and include hypertension, hyperlipidemia, diabetes, smoking, family history, age, Gout was associated with 3-fold higher prevalence of the metabolic syndrome [7]. Gout was associated with a higher prevalence of risk factors for MI, namely hyperlipidemia, hypertension, obesity, and diabetes [8]. Gout was associated with a 1.6-fold higher risk of incident CAD, after adjusting for systolic blood pressure, total cholesterol, alcohol intake, body mass index, and diabetes [9]; but in a case–control study, gout was not significantly associated with incident CAD after

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