Patients with Gout More Likely to Experience Stroke, Heart Failure

Results of a longitudinal follow-up study retrospectively revealed Korean patients with gout, particularly those aged ≥60 years, were more likely to be diagnosed with ischemic heart disease, heart failure, or stroke compared with controls, according to research published in Frontiers in Endocrinology.¹

“Accumulating evidence from other countries indicates potential associations between gout and cardiovascular diseases; however, the associations of gout with cardiovascular diseases, particularly stroke, ischemic heart disease, and heart failure, remain ambiguous in the Korean population,” wrote a group of Korean investigators.

Previous research has demonstrated a 1.49-fold greater risk of overall cardiovascular diseases without accounting for confounding factors, including smoking, alcohol intake, body mass index (BMI), and lifestyle.² Additionally, a meta-analysis study showed a link between uric acid-lowering agents and a decreased risk of myocardial infarction.³ Investigators noted cardiovascular disease caused by gout are anticipated to become more prevalent in the future and should be addressed to increase disease prevention.

A cohort of 22,480 patients with gout and 22,480 controls were obtained from the Korean National Health Insurance Service-Health Screening Cohort (KNHIS-HSC) database, spanning from 2002 – 2019, and retrospectively analyzed. These patients were age-, sex-, income-, and residence-matched 1:1. The relationship between gout and cardiovascular risk was assessed using a Cox proportional hazard model with weighted overlap.

Gout was defined as a condition previously diagnosed or managed ≥2 using an International Classification of Diseases (ICD)-10 (M10) code, and cardiovascular disease was defined as having been hospitalized for ≥2 days or who had died due to stroke, ischemic heart disease, or heart failure.

Compared with controls, the incidences of stroke, ischemic heart disease, or heart failure were slightly higher in patients with gout (stroke: 9.84 vs 8.41 per 1000 person-years; ischemic heart disease: 9.77 vs 7.15 per 1000 person-years; heart failure: 2.47 vs 1.46 per 1000 person-years). After applying the Cox proportional hazard model analysis, patients with gout had an 11% higher likelihood of experiencing a stroke (95% confidence interval [CI] = 1.04 – 1.19, P = .003), a 28% increased risk of ischemic heart disease (95% CI = 1.19 – 1.37, P <.001), and a 64% increased likelihood of experiencing heart failure (95% CI = 1.41 – 1.91, P <.001) over the 16-year period.

Investigators then further categorized groups by sex and age to evaluate any potential link between gout and further incidence of cardiovascular disease. These stratification analyses demonstrated subsequent stroke was more likely in patients with gout aged ≥60 years (hazard ratio [HR] = 1.10, 95% CI = 1.01 – 1.20).

Subgroup analyses by ischemic heart disease remained prominent regardless of age and sex in patients with gout. Heart failure revealed a steady increase in likelihood in patients with gout aged ≥60 years (HR = 1.69, 95% CI = 1.43 – 2.01, P <.001).

Investigators noted limitations including only enrolling Korean patients and relying on diagnosis codes. Therefore, certain confounding factors may not have been taken into consideration. Additionally, data such as family history, diets for gout or heart conditions, and personal genetics were not entered into the KNHIS-HSC database. Other information, such as urate lowering therapies, diuretics, glomerular filtration rate, and creatinine were not provided and therefore not considered in the analyses.

“The findings suggest that individuals diagnosed with gout should receive additional information and training regarding the potential hazards of cardiovascular disease,” concluded investigators.

References

1. ^{Kang HS, Lee NE, Yoo DM, et al. An elevated likelihood of stroke, ischemic heart disease, or heart failure in individuals with gout: a longitudinal follow-up study utilizing the National Health Information database in Korea. Front Endocrinol (Lausanne). 2023;14:1195888. Published 2023 Aug 23. doi:10.3389/fendo.2023.1195888}
2. ^{Liang CW, Islam MM, Poly TN, Yang HC, Jack Li YC. Association between gout and cardiovascular disease risk: A nation-wide case-control study. Joint Bone Spine (2019) 86:389–91. doi: 10.1016/j.jbspin.2018.06.011}
3. ^{Wan H, Zeng L, Xiao R, Tang X, Shu Y, Shen S. Colchicine linked with risk reduction for myocardial infarction in gout patients: systematic review and meta-analysis. Z Rheumatol (2022) 81:501–6. doi: 10.1007/s00393-022-01232-2}