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. 2017 Oct 17;19(1):228.
doi: 10.1186/s13075-017-1427-5.

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Jasvinder A Singh  1   2   3   4 , Rekha Ramachandaran  5 , Shaohua Yu  6 , Shuo Yang  6 , Fenglong Xie  6 , Huifeng Yun  7 , Jie Zhang  7 , Jeffrey R Curtis  6   7
Affiliations

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Jasvinder A Singh et al. Arthritis Res Ther. .

Abstract

Background: Gout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear. Our objective in the present study was to assess whether gout is as strong a risk factor as diabetes mellitus (DM) for incident MI and incident stroke.

Methods: In this retrospective study, we used U.S. claims data from 2007 to 2010 that included a mix of private and public health plans. Four mutually exclusive cohorts were identified: (1) DM only, (2) gout only, (3) gout and DM, and (4) neither gout nor DM. Outcomes were acute MI or stroke with hospitalization. We compared the age- and sex-specific rates of incident MI and stroke across the four cohorts and assessed multivariable-adjusted HRs.

Results: In this study, 232,592 patients had DM, 71,755 had gout, 23,261 had both, and 1,010,893 had neither. The incidence of acute MI was lowest in patients with neither gout nor DM, followed by patients with gout alone, DM alone, and both. Among men >80 years of age, the respective rates/1000 person-years were 14.6, 25.4, 27.7, and 37.4. Similar trends were noted for stroke and in women. Compared with DM only, gout was associated with a significantly lower adjusted HR of incident MI (HR 0.81, 95% CI 0.76-0.87) but a similar risk of stroke (HR 1.02, 95% CI 0.95-1.10). Compared with patients with DM only, patients with both gout and DM had higher HRs for incident MI and stroke (respectively, HR 1.35, 95% CI 1.25-1.47; HR 1.42, 95% CI 1.29-1.56).

Conclusions: Gout is a risk equivalent to DM for incident stroke but not for incident MI. Having both gout and DM confers incremental risk compared with DM alone for both incident MI and stroke.

Keywords: Diabetes; Gout; Myocardial infarction; Risk equivalent; Stroke.

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Conflict of interest statement

Authors’ information

JAS has served as the cochair of the gout working group of the Outcome Measures in Rheumatology (OMERACT) initiative.

Ethics approval and consent to participate

The institutional review board (IRB) at the University of Alabama at Birmingham approved this study, and all investigations were conducted in conformity with ethical principles of research. The IRB waived the need for written informed consent for this retrospective database study.

Consent for publication

Not applicable.

Competing interests

JAS has received research grants from Takeda Pharmaceuticals and Savient Pharmaceuticals and consultant fees from Savient Pharmaceuticals, Takeda Pharmaceuticals, Regeneron Pharmaceuticals, Merz, Bioibérica, Crealta Pharmaceuticals, Allergan, WebMD, UBM LLC, and the American College of Rheumatology (ACR). JAS serves as the principal investigator for an investigator-initiated study funded by Horizon Pharma through a grant to DINORA, Inc., a 501(c)(3) entity. JAS is a member of the executive committee of OMERACT, an organization that develops outcome measures in rheumatology and receives arm’s-length funding from 36 companies; a member of the ACR Annual Meeting Planning Committee; chair of the ACR Meet the Professor, Workshop, and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JRC has received research grant funding via the University of Alabama at Birmingham and consulting monies for unrelated work from AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Pfizer, Roche, and UCB. The other authors declare that they have no competing interests. None of the authors have any other nonfinancial disclosures.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Unadjusted rates/1000 patient-years of incident myocardial infarction (MI) (a and b) and stroke (c and d) based on the presence/absence of diabetes and gout, by age and sex. x-Axis shows the age groups in years, and y-axis shows the incidence rates/1000 patient-years for incident MI in females (a) and males (b) and of incident stroke in females (c) and males (d)
See this image and copyright information in PMC

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