Gender-specific risk factors for incident gout: a prospective cohort study

Abstract

Previous reports suggested that gout incidence increased with serum uric acid (sUA) level. In addition to sUA, we aimed to examine the gender-specific risk factors for incident gout. A prospective study was conducted using data of the MJ Health Screening Center and outcome database from Taiwan's National Health Insurance. Cox proportional hazard model was used for risk analysis of incident gout. During a mean follow-up of 7.31 years for 132,556 individuals aged ≥18 years, 1,606 subjects (1,341 men and 265 women) with clinical gout were defined. Hyperuricemia (sUA ≥7.7 mg/dL for men or ≥6.6 mg/dL for women) was the most important risk factor for gout development with a respective hazard ratio of 9.65 (95% confidence level, 8.53-10.9) for men and 9.28 (7.00-12.3) for women. The age-standardized sUA-gout relationship demonstrated a differential impact of sUA level on gout incidence between men and women. Metabolic comorbidities of hypertension, obesity, and hyperlipidemia were significantly associated with gout with respective HR of 1.32 (1.17-1.48), 1.30 (1.15-1.47), and 1.12 (0.99-1.26) for men and 1.34 (1.02-1.77), 2.15 (1.67-2.76), and 1.70 (1.32-2.19) for women. However, the relationship between diabetes and incident gout was not as prominent. The sex difference of sUA-gout relationship and the association between metabolic comorbidities and incident gout were demonstrated. Generalizability of these findings to other ethnic population needs further investigation.

Definition of hyperuricemia and gouty conditions

“…Another similar study [3] looked at 233 asymptomatic hyperuricemic Taiwanese men followed for 5 years and confirmed that baseline level of uricemia was the main predictor of gout attacks. A more recent study [27] investigated a Taiwanese National Health Insurance database including 60 181 men and 72 375 women free from gout at baseline and followed-up for a mean of 7.31 years. In both sexes, the occurrence of gout increased with baseline uricemia.…”

“…In some articles, the value at which the serum uric acid (SUA) is considered to become abnormal is lower in women than in men, but the retained sex-specific values differ across studies. Hyperuricemia was recently defined as above 7.7 mg/dl in men and above 6.6 mg/dl in women [27], or above 7.0 mg/dl in men and above 5.7 [28] or 6 mg/dl [29] in women. Many investigators defined increased SUA as above 7 mg/dl in men and above 6 mg/dl in women, in line with the recommendations of an epidemiology conference held in Rome in 1963 [30].…”

Impact of obesity and hypertriglyceridemia on gout development with or without hyperuricemia: A prospective study

“…We recently reported the predictability of obesity and dyslipidemia for incident gout, which is more prominent in women than men (6). While a strong association between hyperuricemia and insulin resistance was shown (7,8), the combined effect between hyperuricemia and elements of metabolic syndrome on the development of gout was still uncertain.…”

L’hyperuricémie débute à 360 micromoles (60mg)/L

“…Plusieurs études de suivi ont montré que le risque de goutte augmentait avec l'uricémie [11,[27][28][29][30][31]. Ces études ne se sont intéressées qu'aux gouttes avec manifestations cliniques et n'apportent pas de renseignement sur les dépôts asymptomatiques d'urate tels qu'on les a récem-ment observés en échographie [32].…”

“…L'incidence de l'âge est confirmée par d'autres études. Les données de l'assurance maladie nationale de Taiwan, sur 60 181 hommes et 72 375 femmes sans goutte à l'inclusion ont été suivies pendant une moyenne de 7,31 ans [29]. Dans les 2 sexes, l'incidence de la goutte augmenta avec l'uricémie de départ, mais à uricémie égale, cette incidence augmentait aussi avec l'âge.…”