HPE Grunenthal handbook - Page 17

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 hospitalpharmacyeurope.com | 2018 | 17