Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality

Stack, Austin G.; Hanley, Alan; Casserly, Liam F.; Cronin, Cornelius J.; Abdalla, Ahad; Kiernan, Thomas J.; Murthy, Β. V. R.; Hegarty, Avril; Hannigan, Ailish; Nguyen, Hoang

doi:10.1093/qjmed/hct083

Cited by 134 publications

(89 citation statements)

References 28 publications

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“…Both studies report an ≈60% increase in coronary heart disease or cardiovascular mortality in men with gout, but not in women, regardless of traditional risk factors or diuretic medications. The survey also revealed a gradual increase in cardiovascular mortality dependent on blood uric acid levels 5, 6. In line with this, a prospective study of the Health Professionals Follow‐Up Study confirmed these data by also revealing an ≈60% increase in the risk of fatal coronary heart disease in men with diagnosed gout and a history of CVD 3.…”

Section: Introductionsupporting

confidence: 61%

Gouty Offense in Patients With Obstructive Coronary Artery Disease Despite State‐of‐the‐Art Therapy

Döring

Vorst

2018

JAHA

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Section: Introductionsupporting

confidence: 61%

Gouty Offense in Patients With Obstructive Coronary Artery Disease Despite State‐of‐the‐Art Therapy

Döring

Vorst

2018

JAHA

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“…(5) Hyperuricaemia not only causes painful attacks of gout and joint damage, but is increasingly reported as an independent risk factor for cardiovascular disease and mortality. (6) In the last few years, there has been a resurgence of interest in gout due to the approval of new drugs such as febuxostat and an improved understanding of the inflammasome pathway that mediates the inflammatory response in gout. (7) WHAT SHOULD WE BE ACHIEVING?…”

Section: Introductionmentioning

confidence: 99%

Poorly controlled gout: who is doing poorly?

Chia¹

2016

smedj

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Gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals, is commonly seen in primary care and specialist clinics. In recent years, there has been a resurgence of interest in gout due to advances in therapies and the understanding of pathophysiology, with new guidelines being published by international bodies. However, there is still a gap between the goals of treatment and actual day-to-day practice. Barriers that result in poorly controlled gout include patient factors such as lack of understanding of the disease, stigma and nonadherence to treatment, as well as physician factors such as knowledge gaps, inadequate use of allopurinol and lack of ownership of the disease. The medical profession needs to do more to bridge the gap through physician and patient education, identification of treatment targets with appropriate use of drugs, and dissemination of guidelines.

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“…This increase is particularly concerning given the frequent coexistence of gout and cardiovascular disease (CVD) in the general population 2. Because of many shared risk factors, including hypertension, diabetes mellitus, and obesity,3, 4, 5 the exact nature of the relationship between gout and CVD has remained unclear.…”

mentioning

confidence: 99%

Association of Gout With Long‐Term Cardiovascular Outcomes Among Patients With Obstructive Coronary Artery Disease

Pagidipati

Clare

Keenan

et al. 2018

JAHA

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BackgroundEpidemiological studies demonstrating a relationship between gout and cardiovascular disease are older and predate modern cardiovascular preventive therapy. We assessed the contemporary association between gout and cardiovascular disease in patients with obstructive coronary artery disease.Methods and ResultsData were from the Duke Databank for Cardiovascular Diseases, which followed up patients undergoing cardiac catheterization with obstructive coronary artery disease at Duke University Medical Center (1998–2013). We assessed the relationship between gout diagnosis at baseline or during follow‐up and the primary composite outcome of cardiovascular death, myocardial infarction, or stroke, adjusting for differences in baseline clinical factors. Secondary end points included cardiovascular death and all‐cause mortality. New, postbaseline, gout diagnosis was included as a time‐dependent covariate. Among 17 201 patients, 1406 (8.2%) had baseline gout and a high burden of cardiovascular risk factors, but high rates of optimal medical therapy. Over a median follow‐up of 6.4 years, gout diagnosis at time of catheterization was not associated with the primary outcome (hazard ratio [95% confidence interval], 1.05 [0.96–1.15]; P=0.31) or cardiovascular death (hazard ratio [95% confidence interval], 1.10 [0.99–1.22]; P=0.08), but was associated with increased all‐cause mortality (hazard ratio [95% confidence interval], 1.13 [1.05–1.23]; P=0.002). After including new, postbaseline, gout diagnosis, the instantaneous risk of the primary outcome was significantly associated with prior gout diagnosis (hazard ratio [95% confidence interval], 1.15 [1.07–1.25]; P=0.0004).ConclusionsA clinical history of gout is associated with worse outcomes in a contemporary population of patients with obstructive coronary artery disease. This increased risk exists despite high levels of optimal baseline cardiovascular disease medical therapy, suggesting that residual cardiovascular risk is not addressed by standard medical therapy.

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Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality

Abstract: Gout and serum uric acid independently associate with total and cardiovascular mortality. These risks increase with rising uric acid concentrations.

Cited by 134 publications

References 28 publications

Gouty Offense in Patients With Obstructive Coronary Artery Disease Despite State‐of‐the‐Art Therapy

Gouty Offense in Patients With Obstructive Coronary Artery Disease Despite State‐of‐the‐Art Therapy

Poorly controlled gout: who is doing poorly?

Association of Gout With Long‐Term Cardiovascular Outcomes Among Patients With Obstructive Coronary Artery Disease

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