Associations of Gout and Baseline Serum Urate Level With Cardiovascular Outcomes: Analysis of the Coronary Disease Cohort Study.
Acute Coronary Syndrome
/ epidemiology
Aged
Aged, 80 and over
Cardiovascular Diseases
/ epidemiology
Coronary Artery Disease
/ epidemiology
Female
Follow-Up Studies
Gout
/ blood
Heart Failure
/ epidemiology
Hospitalization
/ statistics & numerical data
Humans
Hyperuricemia
/ blood
Male
Middle Aged
Mortality
New Zealand
/ epidemiology
Proportional Hazards Models
Uric Acid
/ blood
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
30
01
2019
accepted:
30
05
2019
pubmed:
5
6
2019
medline:
25
2
2020
entrez:
5
6
2019
Statut:
ppublish
Résumé
To determine whether gout and serum urate (SU) levels are associated with increased risk of death, time to first readmission for any cardiovascular event, or incident heart failure in individuals with cardiovascular disease. Individuals presenting with an acute coronary syndrome (ACS) were enrolled in the Coronary Disease Cohort Study. Clinical data were collected from the medical records at the index hospital admission, and clinical, echocardiographic, and biochemical data were collected postdischarge. Gout was defined by self-report, use of urate-lowering therapy, or use of colchicine with evidence of gout on review of the medical record. The primary end points were all-cause mortality, time to readmission for a cardiac ischemic event, and time to readmission for heart failure. Data from 1,514 participants were available. During the follow-up period, 53 of 160 participants with gout (33.1%) and 298 of 1,354 participants without gout (22.0%) died. After adjustment for other factors known to be associated with mortality, there was no gout-specific increase in risk of mortality (adjusted hazard ratio 0.98 [95% confidence interval 0.69-1.38]). Time to readmission for heart failure was significantly briefer in those with, compared to those without, gout (adjusted hazard ratio 1.42 [95% confidence interval 1.02-1.97]). Irrespective of whether a participant had gout or not, as SU level increased, there was an increased risk of death and readmission for either a cardiovascular event or heart failure. Survival post-ACS is similar with and without the presence of gout. People with gout are at an increased risk of readmission for heart failure and have longer hospital stays. Risk of these events increases in parallel with increases in SU levels.
Substances chimiques
Uric Acid
268B43MJ25
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1733-1738Subventions
Organisme : Health Research Council of New Zealand
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019, American College of Rheumatology.
Références
Keenan T, Zhao W, Rasheed A, Ho WK, Malik R, Felix JF, et al. Causal assessment of serum urate levels in cardiometabolic diseases through a Mendelian randomization study. J Am Coll Cardiol 2016;67:407-16.
Palmer TM, Nordestgaard BG, Benn M, Tybjaerg-Hansen A, Davey Smith G, Lawlor DA, et al. Association of plasma uric acid with ischaemic heart disease and blood pressure: Mendelian randomisation analysis of two large cohorts. BMJ 2013;347:f4262.
White J, Sofat R, Hemani G, Shah T, Engmann J, Dale C, et al. Plasma urate concentration and risk of coronary heart disease: a Mendelian randomisation analysis. Lancet Diabetes Endocrinol 2016;4:327-36.
Pagidipati NJ, Hess CN, Clare RM, Akerblom A, Tricoci P, Wojdyla D, et al. An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome. Am Heart J 2017;187:53-61.
Kleber ME, Delgado G, Grammer TB, Silbernagel G, Huang J, Krämer BK, et al. Uric acid and cardiovascular events: a Mendelian randomization study. J Am Soc Nephrol 2015;26:2831-8.
Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007;116:894-900.
White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, Whelton A, et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med 2018;378:1200-10.
Richards AM, Nicholls MG, Yandle TG, Frampton C, Espiner EA, Turner JG, et al. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation 1998;97:1921-9.
Prickett TC, Doughty RN, Troughton RW, Frampton CM, Whalley GA, Ellis CJ, et al. C-type natriuretic peptides in coronary disease. Clin Chem 2017;63:316-24.
Bredemeier M, Lopes LM, Eisenreich MA, Hickmann S, Bongiorno GK, d'Avila R, et al. Xanthine oxidase inhibitors for prevention of cardiovascular events: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2018;18:24.
Stamp L, Dalbeth N. Urate-lowering therapy for asymptomatic hyperuricaemia: a need for caution. Semin Arthritis Rheum 2017;46:457-64.
Abeles AM, Pillinger MH. Gout and cardiovascular disease: crystallized confusion. Curr Opin Rheumatol 2019;31:118-24.