title: Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality.
abstract: BACKGROUND
  Gout and serum uric acid are associated with mortality but their simultaneous contributions have not been fully evaluated in the general population.
  
  
  OBJECTIVE
  To explore the independent and conjoint relationships of gout and uric acid with mortality in the US population.
  
  
  METHODS
  Mortality risks of gout and serum uric acid were determined for 15 773 participants, aged 20 years or older, in the Third National Health and Nutrition Examination Survey by linking baseline information collected during 1988-1994 with mortality data up to 2006. Multivariable Cox proportional hazards regression determined adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for each exposure and all analyses were conducted in 2011 and 2012.
  
  
  RESULTS
  Compared with subjects without a history of gout, the multivariable HR for subjects with gout were 1.42 (CI 1.12-1.82) for total and 1.58 (CI 1.13-2.19) for cardiovascular mortality. Adjusted HRs per 59.5 µmol/l (1 mg/dl) increase in uric acid were 1.16 (CI 1.10-1.22) for total and cardiovascular mortality and this pattern was consistent across disease categories. In the conjoint analysis, the adjusted HRs for mortality in the highest two uric acid quartiles were 1.64 (CI 1.08-2.51) and 1.77 (CI 1.23-2.55), respectively, for subjects with gout, and were 1.09 (CI 0.87-1.37) and 1.37 (CI (1.11-1.70), respectively, for subjects without gout, compared with those without gout in the lowest quartile. A similar pattern emerged for cardiovascular mortality.
  
  
  CONCLUSIONS
  Gout and serum uric acid independently associate with total and cardiovascular mortality. These risks increase with rising uric acid concentrations.
authors.affiliation: Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland. austin.stack@ul.ie
authors.forename: A G
authors.initials: AG
authors.lastname: Stack
authors.forename: A
authors.initials: A
authors.lastname: Hanley
authors.forename: L F
authors.initials: LF
authors.lastname: Casserly
authors.forename: C J
authors.initials: CJ
authors.lastname: Cronin
authors.forename: A A
authors.initials: AA
authors.lastname: Abdalla
authors.forename: T J
authors.initials: TJ
authors.lastname: Kiernan
authors.forename: B V R
authors.initials: BV
authors.lastname: Murthy
authors.forename: A
authors.initials: A
authors.lastname: Hegarty
authors.forename: A
authors.initials: A
authors.lastname: Hannigan
authors.forename: H T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006073:Gout / Q000097:blood*; D006801:Humans; D033461:Hyperuricemia / Q000453:epidemiology / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid