Cardiovascular Risks in Korean Patients with Gout: Analysis Using a National Health Insurance Service Database

Abstract

Although several epidemiologic studies have shown the association between gout and cardiovascular outcomes, specific risk factors for developing cardiovascular diseases in Asian patients with gout are undisclosed. Thus, the purpose of this study was to investigate risks of cardiovascular outcomes and its related factors in Korean patients with gout. This retrospective clinical study used sampled cohort data from the National Health Insurance Service in Korea. Patients with gout were defined as subjects enlisted with an ICD-10 code (M10). Control patients were selected by frequency matching for age, sex, and index year. Primary outcomes included ischemic heart disease (IHD), congestive heart failure, cerebrovascular disease (CVD), or transient ischemic attack. We calculated the hazard ratio (HR) using Cox regression, adjusting potential confounders including age, sex, lifestyle habits, laboratory results, and medication. We identified 3306 patients with gout and an equal number of matched controls. Multivariate Cox regression analysis showed that gout patients had increased risks of IHD (HR: 1.860, 95% CI: 1.446–2.392), acute myocardial infarction (HR: 3.246, 95% CI: 1.460–7.217), and CVD (HR: 1.552, 95% CI: 1.177–2.036). Old age, current smoking, frequent alcohol intake, high low-density lipoprotein, and diabetes mellitus increased the risk of cardiovascular outcomes, yet hypouricemic agents decreased the risk of cerebrovascular diseases. Our data corroborate that it is crucial to identify and manage traditional cardiovascular risk factors alongside lowering urate levels in patients with gout.

Epidemiology and treatment-related concerns of gout and hyperuricemia in Korean

“…According to the third NHANES, gout is associated with increased prevalence of coexistent hypertension, obesity, diabetes mellitus, CKD, myocardial infarction (MI), heart failure, and stroke [28]. Similarly, using the National Health Insurance Service (NHIS) database, it was reported that Korean population with gout had increased risks for acute MI, ischemic heart disease, and cardiovascular (CV) disease, in descending order [29]. In each study conducted at the same tertiary hospital in 2004 and 2016, respectively, the frequency of metabolic syndrome in gout patients showed a trend towards an increase in 2016 compared to that in 2004 (50.8 vs. 42.2%) [30,31].…”

Administrative regional variation in cardiovascular risk among patients with gout: implications for the management of cardiovascular complications

“…These factors include disease duration ≥2 years, oligo- or polyarthritis, serum urate acid levels >9.1 mg/dL, joint damage, and tophi [ 5 , 7 ]. Another study conducted in Korea with National Health Insurance Service Database suggested old age, current smoking, frequent alcohol intake, high low-density lipoprotein, and diabetes mellitus were risk factors for CV diseases in patients with gout [ 8 ]. Geographical disparities, particularly the distinction between rural and urban locations, may also play a role in influence the risk of CV disease.…”