Gout independent risk factor for myocardial infarction

By Stephanie Leveene

Gout is a significant and independent risk factor for the development of myocardial infarction (MI), even in younger patients and those with no other cardiovascular (CV) risk factors, researchers report in Rheumatology.

The Framingham Study noted that patients with gout, which can occur concurrently with other risk factors for MI, have a 60% increased risk for coronary artery disease. However, this and other studies have primarily focused on elderly patients or those at high risk for CV disease.

In the current study, patients with gout were more likely to have diabetes, hypertension, and coronary heart disease at baseline than those without gout. During a 9-year follow-up period for 704,503 patients aged 20 years or older, the incidence of MI among patients with gout was 2.20 per 1000 person-years. This was significantly greater than the 0.60 events per 1000 person-years rate seen in the comparator group.

After adjustment for age, gender, and CV and metabolic syndrome risk factors, the hazard ratio (HR) for the association of gout with MI was 1.23. Further analysis confirmed this significantly increased risk occurred for all age groups and for patients with no CV risk factors for both overall MI (HR=1.84) and nonfatal MI (HR=1.80). In the patients with gout, the overall risk for MI was slightly higher in men than in women.

The risk for fatal MI was similar between those with and those without gout. However, the investigators' analysis did not include mortality not attributable to the first MI event or MI-related deaths that occurred prior to hospitalization.

Shue-Fen Luo (Chang Gung Memorial Hospital, Guishan Township, Taiwan) and colleagues reviewed information from the Taiwan National Health Insurance database on 704,503 patients aged 20 years or older with no history of MI. Of that group, 26,556 had been diagnosed with gout; 70% were men. Luo and colleagues conclude that their results "strongly support the hypothesis that gout has an impact on MI at an early stage."

"Therefore, vigilant monitoring of gout patients for cardiovascular disease symptoms is necessary."

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