Long-term cardiovascular mortality among middle-aged men with gout.
BACKGROUND
There are limited data available on the association of gouty arthritis (gout) in middle age with long-term cardiovascular disease (CVD) mortality.


METHODS
We performed a 17-year follow-up study of 9105 men, aged 41 to 63 years and at above-average risk for coronary heart disease, who were randomized to the Multiple Risk Factor Intervention Trial and who did not die or have clinical or electrocardiographic evidence of coronary artery disease during the 6-year trial. Risk of CVD death and other causes subsequent to the sixth annual examination associated with gout was assessed by means of Cox proportional hazards regressions.


RESULTS
The unadjusted mortality rates from CVD among those with and without gout were 10.3 per 1000 person-years and 8.0 per 1000 person-years, respectively, representing an approximately 30% greater risk. After adjustment for traditional risk factors, use of diuretics and aspirin, and serum creatinine level, the hazard ratio (gout vs no gout) for coronary heart disease mortality was 1.35 (95% confidence interval [CI], 1.06-1.72). The hazard ratio for death from myocardial infarction was 1.35 (95% CI, 0.94-1.93); for death from CVD overall, 1.21 (95% CI, 0.99-1.49); and for death from any cause, 1.09 (95% CI, 1.00-1.19) (P = .04). The association between hyperuricemia and CVD was weak and did not persist when analysis was limited to men with hyperuricemia without a diagnosis of gout.


CONCLUSIONS
Among middle-aged men, a diagnosis of gout accompanied by an elevated uric acid level imparts significant independent CVD mortality risk.


BACKGROUND
clinicaltrials.gov Identifier: NCT00000487.
Krishnan
Eswar
E
Division of Rheumatology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. e.krishnan@stanford.edu
Svendsen
Kenneth
K
Neaton
James D
JD
Grandits
Greg
G
Kuller
Lewis H
LH
D000328:Adult; D015210:Arthritis, Gouty / Q000097:blood / Q000150:complications*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D033461:Hyperuricemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*
D014527:Uric Acid