Gout and Subsequent Increased Risk of Cardiovascular Mortality in Non-diabetics Aged 50 and Above: a Population-based Cohort Study in Taiwan

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2012 Nov 23

PMID 23170782

Citations 19

Authors

Victor C Kok

Jorng-Tzong Horng

Hsin-Li Lin

Yu-Ching Chen

Yan-Jun Chen

Kuang Fu Cheng

Affiliations

Soon will be listed here.

Abstract

Background: Limited data are available on the risk ratios for fatal cardiovascular disease (CVD) outcome from gout and chronic kidney disease (CKD) in non-diabetic individuals.

Methods: Nationwide population-based retrospective prospective study with a 5-year follow-up to investigate the association between physician-diagnosed gout and CKD in non-diabetics aged 50 and above who had no pre-existing serious CVD and the subsequent risk of death from CVD. Hazard ratios (HR) of CVD mortality were adjusted for gender, age, smoking- and alcoholism-related diagnoses, hypertension, hyperlipidemia, atrial fibrillation and Charlson's comorbidity index score.

Results: A case cohort (n=164,463) having gout and a control cohort (n=3,694,377) having no gout were formed. The prevalence of gout in this study was 4.26% whereas that of gout plus CKD was 8.17%. Male to female ratio among the individuals with gout was 3.2:1. The relative risk (RR) of subsequent cardiovascular mortality between the case and control cohort was 1.71 (95% confidence interval (CI), 1.66-1.75). The presence of CKD in nondiabetic subjects with no gout (control group) has a RR of CVD mortality at 3.05 (95% CI, 2.94-3.15). The presence of gout has protective effect on subjects with CKD with a RR of 1.84 (95% CI, 1.71-1.98). As compared with individuals with no gout, the adjusted HR (aHR) for CVD mortality among the individuals with gout was 1.10 (95% CI 1.07-1.13). In a Cox model, when compared with subjects having neither gout nor CKD, the aHR in subjects with no gout but with CKD is 1.76 (95% CI, 1.70-1.82); in subjects with gout but without CKD, 1.10 (1.07-1.13); interestingly, the aHR is attenuated in subjects with concomitant gout plus CKD which is 1.38 (1.29-1.48).

Conclusions: Among non-diabetic individuals aged 50 years or above who had no preceding serious CVD, those with gout were 1.1 times more likely to die from CVD as were individuals without gout. The presence of gout appears to attenuate the risk of subsequent CV mortality in subjects with CKD. Further studies should focus on finding an explanation for the protective effect of gout on CV mortality in patients with CKD.

Citing Articles

Impact of gout on cardiovascular disease mortality: a meta-analysis.

Yuan J, Xie Z, Pan B, Zhang J Z Rheumatol. 2024; 83(Suppl 3):329-337.

PMID: 38302663 DOI: 10.1007/s00393-024-01479-x.

Incident Gout: Risk of Death and Cause-Specific Mortality in Western Sweden: A Prospective, Controlled Inception Cohort Study.

Dehlin M, Sandstrom T, Jacobsson L Front Med (Lausanne). 2022; 9:802856.

PMID: 35280894 PMC: 8907510. DOI: 10.3389/fmed.2022.802856.

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis.

Cox P, Gupta S, Zhao S, Hughes D Rheumatol Int. 2021; 41(7):1209-1219.

PMID: 33987709 PMC: 8164620. DOI: 10.1007/s00296-021-04876-6.

Asymptomatic hyperuricemia and coronary flow reserve in patients with metabolic syndrome.

Kim S, Di Carli M, Garg R, Vanni K, Wang P, Wohlfahrt A BMC Rheumatol. 2019; 2:17.

PMID: 30886968 PMC: 6390615. DOI: 10.1186/s41927-018-0027-6.

Positive association between hypertension and urinary bladder cancer: epidemiologic evidence involving 79,236 propensity score-matched individuals.

Kok V, Zhang H, Lin C, Huang S, Wu M Ups J Med Sci. 2018; 123(2):109-115.

PMID: 29911922 PMC: 6055751. DOI: 10.1080/03009734.2018.1473534.

References

Needham D, Scales D, Laupacis A, Pronovost P . A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. J Crit Care. 2005; 20(1):12-9. DOI: 10.1016/j.jcrc.2004.09.007. View

Kuo C, See L, Luo S, Ko Y, Lin Y, Hwang J . Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2009; 49(1):141-6. DOI: 10.1093/rheumatology/kep364. View

Feig D, Kang D, Johnson R . Uric acid and cardiovascular risk. N Engl J Med. 2008; 359(17):1811-21. PMC: 2684330. DOI: 10.1056/NEJMra0800885. View

Quinn M, Cardwell C, Kee F, Maxwell A, Savage G, McCarron P . The finding of reduced estimated glomerular filtration rate is associated with increased mortality in a large UK population. Nephrol Dial Transplant. 2010; 26(3):875-80. DOI: 10.1093/ndt/gfq505. View

Goicoechea M, de Vinuesa S, Verdalles U, Ruiz-Caro C, Ampuero J, Rincon A . Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010; 5(8):1388-93. PMC: 2924417. DOI: 10.2215/CJN.01580210. View

Rhoden E, Teloken C, Lucas M, Rhoden C, Mauri M, Zettler C . Protective effect of allopurinol in the renal ischemia--reperfusion in uninephrectomized rats. Gen Pharmacol. 2002; 35(4):189-93. DOI: 10.1016/s0306-3623(01)00105-7. View

Lotufo P, Gaziano J, Chae C, Ajani U, Buring J, Manson J . Diabetes and all-cause and coronary heart disease mortality among US male physicians. Arch Intern Med. 2001; 161(2):242-7. DOI: 10.1001/archinte.161.2.242. View

Preis S, Hwang S, Coady S, Pencina M, DAgostino Sr R, Savage P . Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation. 2009; 119(13):1728-35. PMC: 2789419. DOI: 10.1161/CIRCULATIONAHA.108.829176. View

Lakka H, Laaksonen D, Lakka T, Niskanen L, Kumpusalo E, Tuomilehto J . The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002; 288(21):2709-16. DOI: 10.1001/jama.288.21.2709. View

10.

Chien K, Hsu H, Sung F, Su T, Chen M, Lee Y . Hyperuricemia as a risk factor on cardiovascular events in Taiwan: The Chin-Shan Community Cardiovascular Cohort Study. Atherosclerosis. 2005; 183(1):147-55. DOI: 10.1016/j.atherosclerosis.2005.01.018. View

11.

Meisinger C, Doring A, Lowel H . Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006; 27(10):1245-50. DOI: 10.1093/eurheartj/ehi880. View

12.

Hu F, Stampfer M, Solomon C, Liu S, Willett W, Speizer F . The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up. Arch Intern Med. 2001; 161(14):1717-23. DOI: 10.1001/archinte.161.14.1717. View

13.

Wen C, Lee Y, Lin W, Huang H, Yao C, Sung P . The metabolic syndrome increases cardiovascular mortality in Taiwanese elderly. Eur J Clin Invest. 2008; 38(7):469-75. DOI: 10.1111/j.1365-2362.2008.01965.x. View

14.

Almdal T, Scharling H, Skov Jensen J, Vestergaard H . The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004; 164(13):1422-6. DOI: 10.1001/archinte.164.13.1422. View

15.

Savill P . Gout is an independent risk factor for MI in women. Practitioner. 2010; 254(1726):7. View

16.

de Jager D, Grootendorst D, Jager K, van Dijk P, Tomas L, Ansell D . Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009; 302(16):1782-9. DOI: 10.1001/jama.2009.1488. View

17.

Teng G, Ang L, Saag K, Yu M, Yuan J, Koh W . Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study. Ann Rheum Dis. 2011; 71(6):924-8. PMC: 3400339. DOI: 10.1136/ard.2011.200523. View

18.

Nitsch D, Lawlor D, Patel R, Carson C, Ebrahim S . The association of renal impairment with all-cause and cardiovascular disease mortality. Nephrol Dial Transplant. 2009; 25(4):1191-9. DOI: 10.1093/ndt/gfp607. View

19.

Gami A, Witt B, Howard D, Erwin P, Gami L, Somers V . Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007; 49(4):403-14. DOI: 10.1016/j.jacc.2006.09.032. View

20.

Luk A, Levin G, Moore E, Zhou X, Kestenbaum B, Choi H . Allopurinol and mortality in hyperuricaemic patients. Rheumatology (Oxford). 2009; 48(7):804-6. PMC: 4481712. DOI: 10.1093/rheumatology/kep069. View