title: Hypertension and the risk of incident gout in a population-based study: the atherosclerosis risk in communities cohort.
abstract: The authors quantified the impact of hypertension on gout incidence in middle-aged white and African American men and women. The Atherosclerosis Risk in Communities Study (ARIC) was a prospective population-based cohort that recruited patients between 1987 and 1989 from 4 US communities. Using a time-dependent Cox proportional hazards model, the authors estimated the adjusted hazard ratio (HR) of incident gout by time-varying hypertension and tested for mediation by serum urate level. There were 10,872 participants among whom 45% had hypertension during follow-up; 43% were men and 21% were African American. Over 9 years, 274 (2.5%) participants developed gout (1.8% of women and 3.5% of men). The unadjusted HR of incident gout was approximately 3 times (HR, 2.87; 95% confidence interval [CI], 2.24-3.78) greater for those with hypertension. Adjusting for confounders resulted in an attenuated but still significant association between hypertension and gout (HR, 2.00; 95% CI, 1.54-2.61). Adjustment for serum urate level further attenuated but did not abrogate the association (HR, 1.36, 95% CI, 1.04-1.79). There was no evidence of effect modification by sex (P=.35), race (P=.99), or obesity at baseline (P=.82). Hypertension was independently associated with increased gout risk in middle-aged African American and white adults. Serum urate level may be a partial intermediate on the pathway between hypertension and gout.
authors.affiliation: From the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. mmcadams@jhsph.edu
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.forename: Janet W
authors.initials: JW
authors.lastname: Maynard
authors.forename: Alan N
authors.initials: AN
authors.lastname: Baer
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D001741:Black or African American; D001161:Arteriosclerosis / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D019058:Community Networks; D016001:Confidence Intervals; D005260:Female; D006073:Gout / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D018570:Risk Assessment; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People