title: Gout and the risk of acute myocardial infarction.
abstract: OBJECTIVE
  To determine if hyperuricemia and gouty arthritis are independent risk factors for acute myocardial infarction (MI) and, if so, whether they are independent of renal function, diuretic use, metabolic syndrome, and other established risk factors.
  
  
  METHODS
  We performed multivariable logistic and instrumental variable probit regressions on data from the Multiple Risk Factor Intervention Trial (MRFIT).
  
  
  RESULTS
  Overall, there were 12,866 men in the MRFIT who were followed up for a mean of 6.5 years. There were 118 events of acute MI in the group with gout (10.5%) and 990 events in the group without gout (8.43%; P = 0.018). Hyperuricemia was an independent risk factor for acute MI in the multivariable regression models, with an odds ratio (OR) of 1.11 (95% confidence interval [95% CI] 1.08-1.15, P < 0.001). In multivariable regressions in which the above risk factors were used as covariates, gout was found to be associated with a higher risk of acute MI (OR 1.26 [95% CI 1.14-1.40], P < 0.001). Subgroup analyses showed that a relationship between gout and the risk of acute MI was present among nonusers of alcohol, diuretics, or aspirin and among those who did not have metabolic syndrome, diabetes mellitus, or obesity. In separate analyses, a relationship between gout and the risk of acute MI was evident among those with and without those hyperuricemia.
  
  
  CONCLUSIONS
  The independent risk relationship between hyperuricemia and acute MI is confirmed. Gouty arthritis is associated with an excess risk of acute MI, and this is not explained by its well-known links with renal function, metabolic syndrome, diuretic use, and traditional cardiovascular risk factors.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. Arthritis.MD@gmail.com
authors.forename: Eswar
authors.initials: E
authors.lastname: Krishnan
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Baker
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Furst
authors.forename: H Ralph
authors.initials: HR
authors.lastname: Schumacher
mesh_terms: D015210:Arthritis, Gouty / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D004232:Diuretics / Q000009:adverse effects; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D004232:Diuretics