Gout is a known risk factor for cardiovascular disease but not for MI and stroke
by Leo Robert, Rheumatology Network October 28, 2017

Gout is a risk equivalent to diabetes for incident stroke, but that is not the case for incident myocardial infarction (MI).
Having both gout and diabetes confers incremental risk for both incident MI and stroke compared with diabetes alone.
In a study in Arthritis Research & Therapy, researchers at the VA Medical Center in Birmingham and the University of Alabama at Birmingham noted that gout is a known risk factor for cardiovascular disease, cardiovascular mortality, and all-cause mortality but that associations between gout and specific cardiovascular outcomes, MI, and stroke are unclear.
The team therefore assessed whether gout is as strong a risk factor as diabetes for incident MI and incident stroke. The aim was also to estimate the increased cardiovascular risk with gout for women and men in various age groups and examine whether gout is additive to diabetes for cardiovascular risk.
The Study
The investigators used U.S. claims data from 2007 to 2010 that included private and public health plans for the retrospective study. Four mutually exclusive cohorts were identified: (1) diabetes only, (2) gout only, (3) gout and diabetes, and (4) neither gout nor diabetes. Patients with gout, diabetes, or both were slightly older and more likely to be men and have rates of comorbidities higher than in the cohort of patients who had neither condition.
Acute MI and stroke with hospitalization were the outcomes. The researchers compared the age- and sex-specific rates of incident MI and stroke across the four cohorts and assessed multivariable-adjusted hazard ratios (HRs).
Results
The key results were as follows:
• The incidence of acute MI was lowest in patients who had neither gout nor diabetes, followed by patients who had gout alone, diabetes alone, and both
• Among men older than age 80, the rates/1,000 person-years for these cohorts were 14.6, 25.4, 27.7, and 37.4, respectively
• Similar trends were noted for stroke and in women
• The rates for MI and stroke increased with age in all four cohorts
• Compared with diabetes only, gout was associated with a significantly lower adjusted HR of incident MI but a similar risk of stroke
• HRs for incident MI and stroke were higher in patients who had both gout and diabetes compared with patients who had diabetes only
Implications
The researchers cited the following as the main implications for clinicians:
• Recognition of gout as a cerebrovascular risk equivalent to diabetes implies that primary, secondary, and tertiary prevention of stroke may be needed in patients who have gout to reduce the increased risk
• Screening for risk factors for stroke (hypertension, diabetes, hyperlipidemia) and aggressive treatment may be warranted in patients who have gout
• Whether physicians may consider empiric use of lipid-lowering agents in a subgroup of patients with gout at high risk for cardiovascular events remains to be seen
• Optimal treatment of gout that targets both hyperuricemia and systematic inflammation may be needed to reduce stroke risk in patients who have gout
• To what extent each of these strategies reduces the risk of stroke in patients who have gout might be determined in large-sample observational studies or randomized trials of high-risk patients
• Cardiovascular disease prevention and treatment strategies that are in place for patients with diabetes may be applicable to patients who have gout
• By showing that gout is a cerebrovascular risk equivalent of diabetes for stroke, which is associated with high cardiovascular mortality, this study supports the previous finding that linked gout to higher overall mortality.
Conclusions
“As an inflammatory disease commonly associated with high comorbidity load (hypertension, diabetes, hyperlipidemia, obesity, renal failure) and systemic inflammation, gout can be effectively treated with inexpensive generic medications,” the authors concluded.
“On the basis of our study results, the presence of gout should alert physicians to screen, diagnose, and promptly treat cardiovascular risk factors (hypertension, hyperlipidemia), similar to the approach used in patients with diabetes.”

This article originally appeared on our partner’s website Rheumatology Network, which is a part of UBM Medica. (Free registration is required.)
last updated 10.27.2017
• Primary Source
Arthritis Research & Therapy
Source Reference: Singh JA, et al. “Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study.” Arthritis Res Ther 2017 DOI: 10.1186/s13075-017-1427-5.