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Long-term Cardiovascular Mortality Among Middle-aged Men With Gout
Eswar Krishnan, MD, MPH;
Kenneth Svendsen, MS;
James D. Neaton, PhD;
Greg Grandits, MS;
Lewis H. Kuller, MD; for the MRFIT Research Group
Arch Intern Med. 2008;168(10):1104-1110.
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.
Conclusion Among middle-aged men, a diagnosis of gout accompanied by an elevated uric acid level imparts significant independent CVD mortality risk.
Trial Registration clinicaltrials.gov Identifier: NCT00000487
Author Affiliations: Division of Rheumatology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Krishnan); Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis (Messrs Svendsen and Grandits and Dr Neaton); and Department of Epidemiology, University of Pittsburgh School of Public Health (Dr Kuller). Dr Krishnan is now with the Department of Medicine, Stanford University, Palo Alto, California.
Group Information: A list of the original Multiple Risk Factor Intervention Trial (MRFIT) investigators who made this study possible was published in JAMA. 1982;248(12):1465-1477.
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