title: Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction.
abstract: BACKGROUND
  Patients with a history of myocardial infarction (MI) are often at risk for complications, including subsequent MI and death. Use of prognostic markers may aid in preventing these poor outcomes. Hyperuricemia is associated with increased risk for coronary heart disease (CHD) and/or mortality; however, it is unknown if serum urate (sUA) levels predict outcomes in patients with previous MI. The purpose of this study was to assess hyperuricemia as a biomarker of CHD outcomes in such patients.
  
  
  METHODS
  These were post hoc analyses of datasets from the Aspirin Myocardial Infarction Study, a 1:1 randomized, double-blind clinical trial, conducted from 1975 to 1979, that examined mortality rates following daily aspirin administration over three years in individuals with documented MI. The primary outcome measures were all-cause death, CHD mortality, coronary incidence, and stroke by quartile of baseline sUA. A sub-analysis of all outcome measures in the presence or absence of gouty arthritis was also performed.
  
  
  RESULTS
  Of 4,524 enrolled participants, data on 4,352 were analyzed here. All outcomes were greatest for patients in the fourth sUA quartile. In multivariate regression models, the hazard ratios (HR) for patients in the highest quartile were 1.88 for all-cause mortality (95% confidence interval (CI), 1.45 to 2.46), 1.99 for CHD mortality (95% CI, 1.49 to 2.66), and 1.36 for coronary incidence (95% CI, 1.08 to 1.70). Participants with untreated gout had an adjusted hazard ratio ranging from 1.5 to 2.0 (all P < 0.01) for these outcomes. Participants with gout who were receiving treatment did not exhibit this additional risk.
  
  
  CONCLUSIONS
  sUA and untreated gout may be independent prognostic markers for poor all-cause and CHD mortality in patients with recent acute MI.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, CA 94304, USA. e.krishnan@stanford.edu
authors.forename: Eswar
authors.initials: E
authors.lastname: Krishnan
authors.forename: Bhavik J
authors.initials: BJ
authors.lastname: Pandya
authors.forename: Bharathi
authors.initials: B
authors.lastname: Lingala
authors.forename: Ali
authors.initials: A
authors.lastname: Hariri
authors.forename: Omar
authors.initials: O
authors.lastname: Dabbous
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000401:mortality; D003327:Coronary Disease / Q000097:blood / Q000150:complications / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006073:Gout / Q000097:blood* / Q000145:classification; D006801:Humans; D033461:Hyperuricemia / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications / Q000401:mortality; D014527:Uric Acid / Q000097:blood*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014527:Uric Acid; D001241:Aspirin