Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

Colantonio, Lisandro D.; Singh, Jasvinder A; Chen, Ligong; Reynolds, Richard J.; Gaffo, Angelo L.; Plante, Timothy B; Curtis, Jeffrey R.; Bridges, S. Louis; Levitan, Emily B; Chaudhary, Ninad S.; Howard, George; Safford, Monika M.; Muntner, Paul; Irvin, Marguerite R.

doi:10.1186/s13075-020-02175-2

Cited by 23 publications

(21 citation statements)

References 52 publications

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“…Hyperuricaemia has been linked with an increased incidence of both coronary heart disease (CHD) and cerebrovascular accident (CVA) [6,7]. Several studies have found gout to be associated with an increased risk of cardiovascular diseases, such as CHD and CVA, but the evidence is conflicting [8][9][10][11]. Furthermore, there have been no previous reviews assessing the prevalence of venous thromboembolism (VTE) in patients with gout.…”

Section: Introductionmentioning

confidence: 99%

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

et al. 2021

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The aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

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Section: Introductionmentioning

confidence: 99%

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

et al. 2021

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“…In the studies in younger populations with mean a age og <50 years old, urate-lowering therapy was associated with lowered coronary artery disease and stroke hospitalization, but not heart failure hospitalization, compared to non-urate lowering therapy in gout patients ( 16 , 17 ). In particular, gout was associated with an increased risk of HF, rather than an increased incidence of coronary heart disease, stroke, or all-cause mortality, in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study ( 18 ). Meanwhile, serum uric acid level was known to be associated with incident cardiovascular events and could be an important prognostic factor for patients with HF ( 19 – 21 ).…”

Section: Discussionmentioning

confidence: 99%

Sex difference in heart failure risk associated with febuxostat and allopurinol in gout patients

Cheng

Yen²,

Su³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundGout or rapid reduction in serum uric acid level may increase the incidence of heart failure (HF). To compare the risk of HF between febuxostat and allopurinol in gout patients with coexisting cardiovascular (CV) diseases, the varying severity would be likely to confound the risk estimation. Gout and HF are both sex-related diseases, and the risk difference from the urate-lowering agents between women and men remains unknown.AimsTo evaluate the HF hospitalisations risk of febuxostat and allopurinol in gout patients in real-world settings.MethodsA population-based cohort enrolled patients with allopurinol or febuxostat initiation from 2011 to 2018. Participants were grouped into, without (low CV risk group) or with (high CV risk group) a history of recent major CV admission. The primary outcome was HF hospitalization. The secondary outcomes were composite CV events, all-cause mortality, and the cause of CV mortality. We used the ‘as-treated' analysis and Cox proportional hazards model after propensity score (PS) matching. Patients were further stratified into men and women to evaluate the gender differences.ResultsFebuxostat users had a significantly higher risk of HF hospitalization than allopurinol users in gout patients either with low CV risk [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.25–1.55] or high CV risk [HR 1.36; 95% CI 1.22–1.52]. Particularly, women with gout had a higher risk of HF hospitalization than men.ConclusionThe HF hospitalization risk was highest in gout women with high CV risk and febuxostat use. Monitoring of HF is warranted in these patients.

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“…According to current studies, hyperuricemia is associated with population mortality [27], affects the occurrence and progression of heart and kidney disease, and can be used as a predictor of obesity and metabolic syndrome [28][29][30]. A cohort study of people with heart failure found that hyperuricemia increases the risk of progression in patients with heart failure [31]. In our study, we found that the plasma levels of S-Klotho may have a protective effect against hyperuricemia in middle-aged and elderly people, so it is important to understand the effect of S-Klotho on hyperuricemia for middle-aged and elderly people, as well as clarify the potential bene ts and risks of S-Klotho in these population groups.…”

Section: Discussionmentioning

confidence: 99%

Plasma S-Klotho level affects the risk of hyperuricemia in the middle-aged and elderly people

Xie

Zhou

et al. 2022

Preprint

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Background:Soluble Klotho (S-Klotho) is an anti-aging protein mainly secreted by the kidneys. Hyperuricemia is prevalent among middle-aged and elderly individuals, which affects the development of various chronic diseases. However, there are relatively few studies investigating the association between plasma S-Klotho levels and hyperuricemia in middle-aged and elderly individuals. This study sought to clarify the relationship between S-Klotho and the risk of hyperuricemia in middle-aged and elderly people.Methods:During 2007-2016, a total of 50,588 people participated in the National Health and Nutrition Examination Survey. Finally, 12,498 middle-aged and elderly people (aged 40-79) completed the soluble Klotho tests and had obtained complete data. S-Klotho was detected by ELISA kit, and the relationship between S-Klotho and hyperuricemia was assessd by multiple logistic regression. Hyperuricemia is defined as serum uric acid levels higher than or equal to 420 mmol/L in men and 360 mmol/L in women.Results:In the middle-aged and elderly, plasma S-Klotho levels were negatively correlated with hyperuricemia, and there was a saturation effect. The inflection point of S-Klotho was 850.9 pg/ml (logarithmic likelihood ratio test <0.001). When plasma S-Klotho <850.9 pg/ml, the prevalence of hyperuricemia in middle-aged and elderly individuals with higher levels of S-Klotho decreased by 27.1% compared with those with low levels of S-Klotho[Q4 vs Q1, OR: 0.729, 95%CI: (0.615, 0.863), P < 0.001]; In different age groups, S-Klotho had a significantly greater effect on hyperuricemia in middle-aged people[Age: 40-65years, Q4 vs Q1, OR(95%CI): 0.64, (0.55, 0.76), P <0.001; Age>65 years: Q4 vs Q1, OR(95%CI): 0.67, (0.53, 0.85), P =0.001)] .When the level of S-Klotho was higher, the risk of hyperuricemia in men was lower than that in women [male: Q4 vs Q1, OR(95%CI): 0.64, (0.53, 0.77), P <0.001; female: Q4 vs Q1 (95%CI):0.66, (0.54, 0.81), P <0.001].Conclusions:In middle-aged and elderly individuals, plasma S-Klotho levels were inversely correlated with hyperuricemia, with a saturation effect. Given the limitations of the research results, the underlying mechanism between S-Klotho and hyperuricemia should be further explored.

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Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

Cited by 23 publications

References 52 publications

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

Sex difference in heart failure risk associated with febuxostat and allopurinol in gout patients

Plasma S-Klotho level affects the risk of hyperuricemia in the middle-aged and elderly people

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