Abstract
BackgroundGout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear. Our objective in the present study was to assess whether gout is as strong a risk factor as diabetes mellitus (DM) for incident MI and incident stroke.MethodsIn this retrospective study, we used U.S. claims data from 2007 to 2010 that included a mix of private and public health plans. Four mutually exclusive cohorts were identified: (1) DM only, (2) gout only, (3) gout and DM, and (4) neither gout nor DM. Outcomes were acute MI or stroke with hospitalization. We compared the age- and sex-specific rates of incident MI and stroke across the four cohorts and assessed multivariable-adjusted HRs.ResultsIn this study, 232,592 patients had DM, 71,755 had gout, 23,261 had both, and 1,010,893 had neither. The incidence of acute MI was lowest in patients with neither gout nor DM, followed by patients with gout alone, DM alone, and both. Among men >80 years of age, the respective rates/1000 person-years were 14.6, 25.4, 27.7, and 37.4. Similar trends were noted for stroke and in women. Compared with DM only, gout was associated with a significantly lower adjusted HR of incident MI (HR 0.81, 95% CI 0.76–0.87) but a similar risk of stroke (HR 1.02, 95% CI 0.95–1.10). Compared with patients with DM only, patients with both gout and DM had higher HRs for incident MI and stroke (respectively, HR 1.35, 95% CI 1.25–1.47; HR 1.42, 95% CI 1.29–1.56).ConclusionsGout is a risk equivalent to DM for incident stroke but not for incident MI. Having both gout and DM confers incremental risk compared with DM alone for both incident MI and stroke.
Highlights
Gout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear
Using a large cohort of patients who had gout, diabetes, both, or neither, we investigated whether gout was a risk equivalent for incident MI and stroke, similar to diabetes
Our study shows that gout was an independent risk factor for incident MI and of incident stroke in patients without underlying coronary artery disease (CAD)
Summary
Gout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear. Gout was associated with a higher risk of incident myocardial infarction (MI) by 1.23- to 1.82-fold in some studies [5,6,7,8], but it was not associated with higher risk in others [9, 10]. Authors of systematic reviews of observational studies have found hyperuricemia by itself (even in the absence of gout) to be associated with a 1.47 times higher risk of stroke [11] and a 1.34 times higher risk of coronary heart disease (CHD) [12]. Hyperuricemia and associated mechanisms may partially mediate increased cardiovascular risk in patients with gout [6, 11,12,13,14]
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