Risk of Incident Atrial Fibrillation in Gout: a Cohort Study

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2015 Sep 2

PMID 26324846

Citations 22

Authors

Seoyoung C Kim

Jun Liu

Daniel H Solomon

Affiliations

Soon will be listed here.

Abstract

Objective: Atrial fibrillation (AF) is the most common arrhythmia associated with cardiovascular disease and mortality. Recent studies suggest an association between inflammation, hyperuricaemia and AF, but little is known whether gout is associated with AF risk.

Methods: Using data from a US commercial insurance plan (2004-2013), we conducted a cohort study to evaluate the risk of incident AF in patients with gout versus osteoarthritis. Patients with gout or osteoarthritis were identified with ≥2 diagnoses and ≥1 dispensing for gout or osteoarthritis medications. Incident AF was defined as a new AF diagnosis and a new dispensing for anticoagulants or antiarrhythmics. The risk of incident AF in gout was also compared with the non-gout group.

Results: We identified 70 015 patients with gout and 210 045 with osteoarthritis, matched on age, sex and index date. The mean age was 57 years, and 81% were men. Over the mean 2-year follow-up, the incidence rate of AF per 1000 person-years was 7.19 in gout and 5.87 in osteoarthritis. The age, sex and index date-matched HR of AF was 1.23 (95% CI 1.14 to 1.32) in gout versus osteoarthritis. In a multivariable Cox regression, adjusting for age, sex, comorbidities, medications and healthcare usage, the HR of AF in gout was 1.13 (95% CI 1.04 to 1.23). When compared with non-gout, the multivariable HR of AF in gout was also increased (HR 1.21, 95% CI 1.11 to 1.33).

Conclusions: In this large population-based cohort study, gout was associated with a modestly increased risk of incident AF compared with osteoarthritis and non-gout after adjusting for other risk factors.

Citing Articles

Hyperuricemia and Gout are Associated with the Risk of Atrial Fibrillation: An Updated Meta-Analysis.

Deng Y, Li Q, Zhou F, Cai B, Guo J, Li G Rev Cardiovasc Med. 2024; 23(5):178.

PMID: 39077615 PMC: 11273668. DOI: 10.31083/j.rcm2305178.

Managing Gout in Patients with Metabolic Syndrome.

Ebstein E, Ottaviani S Drugs Aging. 2024; 41(8):653-663.

PMID: 39060816 DOI: 10.1007/s40266-024-01132-x.

Evaluation of New Potential Inflammatory Markers in Patients with Nonvalvular Atrial Fibrillation.

Martins G, Duarte R, Vieira E, Rocha N, Figueiredo E, Silveira F Int J Mol Sci. 2023; 24(4).

PMID: 36834735 PMC: 9964249. DOI: 10.3390/ijms24043326.

Potential Association of Osteoporosis and Not Osteoporotic Fractures in Patients with Gout: A Longitudinal Follow-Up Study.

Kwon M, Park J, Kim S, Kim J, Lim H, Kim J Nutrients. 2023; 15(1).

PMID: 36615792 PMC: 9823608. DOI: 10.3390/nu15010134.

The Risk of BPPV, Meniere's Disease, and Vestibular Neuronitis in Patients with Gout: A Longitudinal Follow-Up Study Using a National Health Screening Cohort.

Choi H, Kim S, Chung J J Clin Med. 2023; 12(1).

PMID: 36614986 PMC: 9821089. DOI: 10.3390/jcm12010185.

References

Gagne J, Glynn R, Avorn J, Levin R, Schneeweiss S . A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol. 2011; 64(7):749-59. PMC: 3100405. DOI: 10.1016/j.jclinepi.2010.10.004. View

Kim S, Guevara J, Kim K, Choi H, Heitjan D, Albert D . Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2010; 62(2):170-80. PMC: 3156692. DOI: 10.1002/acr.20065. View

Engelmann M, Svendsen J . Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J. 2005; 26(20):2083-92. DOI: 10.1093/eurheartj/ehi350. View

Cicero A, Rosticci M, Tocci G, Bacchelli S, Urso R, DAddato S . Serum uric acid and other short-term predictors of electrocardiographic alterations in the Brisighella Heart Study cohort. Eur J Intern Med. 2015; 26(4):255-8. DOI: 10.1016/j.ejim.2015.02.007. View

Andersson T, Magnuson A, Bryngelsson I, Frobert O, Henriksson K, Edvardsson N . All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study. Eur Heart J. 2013; 34(14):1061-7. PMC: 3618889. DOI: 10.1093/eurheartj/ehs469. View

Patti G, Chello M, Candura D, Pasceri V, DAmbrosio A, Covino E . Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation. 2006; 114(14):1455-61. DOI: 10.1161/CIRCULATIONAHA.106.621763. View

De Vera M, Rahman M, Bhole V, Kopec J, Choi H . Independent impact of gout on the risk of acute myocardial infarction among elderly women: a population-based study. Ann Rheum Dis. 2010; 69(6):1162-4. PMC: 3142935. DOI: 10.1136/ard.2009.122770. View

Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T . Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2007; 67(7):960-6. PMC: 2564789. DOI: 10.1136/ard.2007.076232. View

Liu T, Li G, Li L, Korantzopoulos P . Association between C-reactive protein and recurrence of atrial fibrillation after successful electrical cardioversion: a meta-analysis. J Am Coll Cardiol. 2007; 49(15):1642-1648. DOI: 10.1016/j.jacc.2006.12.042. View

10.

Guo Y, Lip G, Apostolakis S . Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012; 60(22):2263-70. DOI: 10.1016/j.jacc.2012.04.063. View

11.

Krahn A, Manfreda J, Tate R, Mathewson F, Cuddy T . The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995; 98(5):476-84. DOI: 10.1016/S0002-9343(99)80348-9. View

12.

Hu Y, Chen Y, Lin Y, Chen S . Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015; 12(4):230-43. DOI: 10.1038/nrcardio.2015.2. View

13.

Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J . Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006; 440(7081):237-41. DOI: 10.1038/nature04516. View

14.

Singh J, Strand V . Gout is associated with more comorbidities, poorer health-related quality of life and higher healthcare utilisation in US veterans. Ann Rheum Dis. 2008; 67(9):1310-6. DOI: 10.1136/ard.2007.081604. View

15.

Imazio M, Brucato A, Ferrazzi P, Rovere M, Gandino A, Cemin R . Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011; 124(21):2290-5. DOI: 10.1161/CIRCULATIONAHA.111.026153. View

16.

Tamariz L, Hernandez F, Bush A, Palacio A, Hare J . Association between serum uric acid and atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm. 2014; 11(7):1102-8. DOI: 10.1016/j.hrthm.2014.04.003. View

17.

Kim S, Schmidt B, Franklin J, Liu J, Solomon D, Schneeweiss S . Clinical and health care use characteristics of patients newly starting allopurinol, febuxostat, and colchicine for the treatment of gout. Arthritis Care Res (Hoboken). 2013; 65(12):2008-14. PMC: 4096791. DOI: 10.1002/acr.22067. View

18.

Gungor B, Ekmekci A, Arman A, Ozcan K, Ucer E, Alper A . Assessment of interleukin-1 gene cluster polymorphisms in lone atrial fibrillation: new insight into the role of inflammation in atrial fibrillation. Pacing Clin Electrophysiol. 2013; 36(10):1220-7. DOI: 10.1111/pace.12182. View

19.

Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo M, Maseri A . Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997; 96(4):1180-4. DOI: 10.1161/01.cir.96.4.1180. View

20.

Amaral F, Costa V, Tavares L, Sachs D, Coelho F, Fagundes C . NLRP3 inflammasome-mediated neutrophil recruitment and hypernociception depend on leukotriene B(4) in a murine model of gout. Arthritis Rheum. 2011; 64(2):474-84. DOI: 10.1002/art.33355. View