title: Effect of Urate-lowering Therapy on the Risk of Cardiovascular Disease and All-cause Mortality in Patients with Gout: A Case-matched Cohort Study.
abstract: OBJECTIVE
  To examine (1) the risk of death from cardiovascular disease (CVD) and from all causes in patients with gout who do not undergo urate-lowering therapy (ULT), and (2) the effect of ULT on mortality risk in patients with gout.
  
  
  METHODS
  In this prospective case-matched cohort study, 40,623 Taiwanese individuals aged ≥ 17 years were followed for 6.5 years. Mortality rate was compared between 1189 patients with gout who did not receive ULT and reference subjects (no gout, no ULT) matched for age, sex, and the index date of gout diagnosis (1:3 patients with gout/reference subjects), and between 764 patients with gout who received ULT and 764 patients with gout who did not receive ULT matched 1-to-1 based on their propensity score and the index date of ULT prescription. Cox proportional hazard modeling was used to estimate the respective risk of CVD (International Classification of Diseases, 9th ed. code 390-459) and all-cause mortality.
  
  
  RESULTS
  After adjustment, patients with gout not treated with ULT had an increased risk of CVD mortality (HR 2.43, 95% CI 1.33-4.45) and all-cause mortality (1.45, 1.05-2.00) relative to the matched reference subjects (no gout, no ULT). Patients with gout treated with ULT had a lower risk of CVD (0.29, 0.11-0.80) and all-cause mortality (0.47, 0.29-0.79) relative to patients with gout not treated with ULT. This survival benefit persisted for users of either allopurinol or benzbromarone.
  
  
  CONCLUSIONS
  Patients with gout who received ULT had significantly better survival rates than those who did not. Thus, undertreatment of gout has serious negative consequences.
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes. d91842001@ntu.edu.tw.
authors.forename: Jiunn-Horng
authors.initials: JH
authors.lastname: Chen
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Joung-Liang
authors.initials: JL
authors.lastname: Lan
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Chi-Fung
authors.initials: CF
authors.lastname: Cheng
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Wen-Miin
authors.initials: WM
authors.lastname: Liang
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Hsiao-Yi
authors.initials: HY
authors.lastname: Lin
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tsay
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Wen-Ting
authors.initials: WT
authors.lastname: Yeh
authors.affiliation: From the School of Medicine, China Medical University, Section of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital; Department of Public Health, and Graduate Institute of Biostatistics, Biostatistics Center, China Medical University; Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung; School of Medicine, National Yang-Ming University, Section of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Veterans General Hospital; Institute of Biomedical Sciences, Academia Sinica, Taipei; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.J.H. Chen, MD, PhD, Associate Professor, China Medical University, China Medical University Hospital; J.L. Lan, MD, Professor, China Medical University, China Medical University Hospital; C.F. Cheng, MSc; W.M. Liang, PhD, Professor, China Medical University; H.Y. Lin, MD, Associate Professor, National Yang-Ming University, Veterans General Hospital; G.J. Tsay, MD, PhD, Professor, Chung-Shan Medical University; W.T. Yeh, MSc, Academia Sinica; W.H. Pan, PhD, Professor, Academia Sinica, National Health Research Institutes.
authors.forename: Wen-Harn
authors.initials: WH
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D005260:Female; D006073:Gout / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006074:Gout Suppressants
keywords: ALLOPURINOL; BENZBROMARONE; GOUT; MORTALITY; URATE-LOWERING THERAPY