Thursday, August 23, 2007

Gout increases risk for CVD, CHD death

Gout increases risk for CVD, CHD death

By Caroline Price (MedWire News)

23 August 2007

Circulation 2007; 116: 894-900

MedWire News: In men without pre-existing coronary heart disease (CHD), gout increases mortality due to an increased risk for cardiovascular disease (CVD) death, in particular due to CHD, clinicians report.

The study provides the first prospective data on the impact of gout on mortality, they say, and supports aggressive management of CV risk factors in patients with gout.

Hyon Choi (University of British Columbia, Vancouver, Canada) and colleagues prospectively evaluated the association between gout and future risk for death and MI in 51,297 men participating in the Health Professionals Follow-Up study.

Over 12 years of follow-up, the relative risks (RRs) in men with history of gout but no history of CHD compared with those with no history of gout or CHD at baseline were 1.28 for all-cause mortality, 1.38 for CVD deaths, and 1.55 for fatal CHD.

Corresponding RRs among men with history of gout and pre-existing CHD relative to those without history of gout but pre-existing CHD were 1.25, 1.26, and 1.24, the team reports in the journal Circulation.

When the researchers repeated the analysis every 2 years during follow-up using data updated for gout and CHD status, meaning more deaths were assigned to men with a history of gout, CHD, or both categories, the overall findings were similar.

Results were also similar using only incident cases of gout after excluding cases of gout at baseline, they note.

“Of note, the magnitude of the excess risk for CHD deaths (55%) was similar to that for nonfatal myocardial infarction associated with incident cases of confirmed gout (59%),” Choi et al comment.

“These associations were independent of age, body mass index, smoking, family history of MI, use of diuretic and aspirin, dietary risk factors, and risk conditions such as diabetes mellitus, hypercholesterolemia, and hypertension.”

In an accompanying editorial, Michael Alderman welcomed the study, noting that “most present-day clinicians would be surprised that this is the first prospective study linking gout to mortality.”

He said that “despite the absence of women and the narrow professional range of the men studied, there is little reason to quibble with the assertion that the biological impact of gout is probably similar in other groups as well.”

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