Gout and Progression of Aortic Stenosis

Abstract

Background: Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease.

Methods: This retrospective study evaluated consecutive adults age ≥65 years with aortic stenosis between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms (TTEs) separated by at least 1 year. Severe aortic stenosis was defined as any combination of an aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, aortic valve area ≤1 cm², or decrease in left ventricular ejection fraction as a result of aortic stenosis.

Results: Of the 699 study patients, gout was present in 73 patients (10%) and not found in 626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe aortic stenosis on follow-up transthoracic echocardiogram was more frequent in patients with gout compared to those without gout (74% vs 54%, P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without severe aortic stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development of severe aortic stenosis after multivariable adjustment (adjusted hazard ratio [aHR] 1.46 [1.03-2.08], P = 0.03). The annualized reduction in aortic valve area was numerically greater in the group with gout compared with the group without gout (-0.10 cm²/y [-0.18, -0.03] vs -0.08 cm²/y [-0.16, -0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between groups.

Conclusions: Progression to severe aortic stenosis was more frequent in patients with gout compared with those without gout, supporting the hypothesis that gout is a risk factor for aortic stenosis.

Keywords: Aortic stenosis; Gout.

Figure 1

Study population. TTE = transthoracic echocardiogram.

Figure 2

(A) Presence of severe aortic stenosis on index and subsequent transthoracic echocardiogram (TTE) in patients with and without gout. (B) Proportion of patients without severe aortic stenosis on the index TTE who had progression to severe aortic stenosis on subsequent TTE.

Figure 3

Annualized change in (A) aortic valve peak velocity, (B) aortic valve mean gradient, and (C) aortic valve between patients with and without gout. Data shown as median [interquartile range] and compared using Mann-Whitney test.