Gout, coronary heart disease (CHD)
and CV mortality
The presence of gout can also increase the incidence
of clinical heart disease in patients with and without
a history of cardiovascular complications (Figure
1). In a cross-sectional study, Chen et al 15 evaluated
the association between severity of gouty arthritis
and Q-wave myocardial infarction after controlling
for several confounding risk factors and found that
increased affected joint count was associated with
acute myocardial infarction. Another study extended
this evidence and showed that gout was more likely
associated with different types of cardiac disease
(CHD, heart failure, stroke, heart revascularisation).
Many studies have investigated the relationship
between serum uric acid and CVD according to
a prospective longitudinal observation. In 1988,
Abbott et al 16 analysed data of the Framingham
Heart Study and showed a 60% excess of coronary
artery disease (CHD) and 80% increased risk of
angina in men with self-reported gout who had not
been treated with diuretics. The association was
significant, after adjusting for the main confounding
risk factors including age, systolic blood pressure,
total cholesterol, alcohol, body mass index, and
diabetes. No significant associations were observed
Over the last ten
years, there has
been a progressive
increased interest
in the association
of gout and heart
disease, guided by
emerging
epidemiologic
data linking the
two diseases
for women, in whom the incidence of gout is
extremely low before the menopause because of the
protective uricosuric effect of oestrogen hormones. 17
The relationship between gout and heart disease
was also investigated in the cohort of subjects
included in the Multiple Risk Factor Intervention
Trial (MRFIT) 8 including 12,866 men at high risk of
coronary artery disease and followed up for a mean
of 6.5 years. Krishnan and colleagues 8 assessed
whether gouty arthritis was a risk factor for acute
MI in the MRFIT cohort, independent of renal
function, diuretic use, metabolic syndrome, and
other established risk factors.
Using multivariable logistic regression adjusted
for these risk factors, they found that gout was
associated with a 26% higher risk of acute MI (95% CI
1.14–1.40). The relationship between gout and risk
of acute MI was evident regardless of the presence of
hyperuricaemia. A second study based on the MRFIT
database investigated the association of gout (based
on self-reported and sustained uric acid >7mg/dl)
with CVD, MI, and CHD death. 8 In a multivariate
model adjusted for age, blood pressure, lipid profile,
renal function, glucose control, dietary habits, drug
treatment (in particular, use of diuretic or aspirin)
and family history of MI, mortality rates from
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