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. 2020 Apr 16;22(1):86.
doi: 10.1186/s13075-020-02175-2.

Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

Lisandro D Colantonio  1 , Kenneth G Saag  2 , Jasvinder A Singh  3   2   4 , Ligong Chen  3 , Richard J Reynolds  2 , Angelo Gaffo  2   4 , Timothy B Plante  5 , Jeffrey R Curtis  3   2 , S Louis Bridges Jr  2 , Emily B Levitan  3 , Ninad S Chaudhary  3 , George Howard  6 , Monika M Safford  7 , Paul Muntner  3 , Marguerite Ryan Irvin  3
Affiliations

Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study

Lisandro D Colantonio et al. Arthritis Res Ther. .

Abstract

Background: Gout has been associated with a higher risk for coronary heart disease (CHD) and stroke in some prior studies. Few studies have assessed the association of gout with incident heart failure (HF).

Methods: We analyzed data from 5713 black and white men and women ≥ 65.5 years of age in the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who had Medicare coverage without a history of HF, CHD, or stroke at baseline between 2003 and 2007. Gout was defined by ≥ 1 hospitalization or ≥ 2 outpatient visits with a diagnosis code for gout in Medicare claims prior to each participant's baseline study examination. REGARDS study participants were followed for HF hospitalization, CHD, stroke, and all-cause mortality as separate outcomes through December 31, 2016. Analyses were replicated in a random sample of 839,059 patients ≥ 65.5 years of age with Medicare coverage between January 1, 2008, and June 30, 2015, who were followed through December 31, 2017.

Results: Among REGARDS study participants included in the current analysis, the mean age at baseline was 72.6 years, 44.9% were men, 31.4% were black, and 3.3% had gout. Over a median follow-up of 10.0 years, incidence rates per 1000 person-years among participants with and without gout were 13.1 and 4.4 for HF hospitalization, 16.0 and 9.3 for CHD, 9.3 and 8.2 for stroke, and 55.0 and 37.1 for all-cause mortality, respectively. After multivariable adjustment for sociodemographic variables and cardiovascular risk factors, hazard ratios (95% CI) comparing participants with versus without gout were 1.97 (1.22, 3.19) for HF hospitalization, 1.21 (0.79, 1.84) for CHD, 0.83 (0.48, 1.43) for stroke, and 1.08 (0.86, 1.35) for all-cause mortality. The multivariable-adjusted hazard ratio for HF hospitalization with reduced and preserved left ventricular ejection fraction among participants with versus without gout was 1.77 (95% CI 0.83, 3.79) and 2.32 (95% CI 1.12, 4.79), respectively. The multivariable-adjusted hazard ratio for heart failure hospitalization associated with gout among the 839,059 Medicare beneficiaries was 1.32 (95% CI 1.25, 1.39).

Conclusion: Among older adults, gout was associated with an increased risk for incident HF but not for incident CHD, incident stroke, or all-cause mortality.

Keywords: Cardiovascular disease; Gout; Heart failure; Risk factors.

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Conflict of interest statement

KGS receives research support from Horizon, Takeda, Ironwood, and Sobi and serves as a consultant/advisor for Sobi, Ironwood, Horizon, and Takeda. JAS received consultant fees from Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health (< $10,000 total each) and the American College of Rheumatology (> $10,000 total); is member of the Executive Committee of Outcome Measures in Rheumatology (OMERACT); and is a stockholder of Amarin pharmaceuticals and Viking therapeutics. EBL, MMS, and PM receive research support from Amgen. EBL also served as a consultant/advisor for Amgen and Novartis. The remaining authors have no disclosures.

Figures

Fig. 1
Fig. 1
Cumulative incidence of HF hospitalization, CHD, stroke, and all-cause mortality among REGARDS study participants. CHD, coronary heart disease; HF, heart failure; REGARDS, REasons for Geographic And Racial Differences in Stroke. Cumulative incidence curves are unadjusted
Fig. 2
Fig. 2
Cumulative incidence of HF, myocardial infarction, and stroke hospitalization and all-cause mortality among Medicare beneficiaries. HF, heart failure. Cumulative incidence curves are unadjusted
See this image and copyright information in PMC

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