Gout Equals Diabetes in Stroke Risk

October 18, 2017

Cardiovascular disease prevention and treatment strategies for patients with diabetes may apply.

Gout is a risk equivalent to diabetes for incident stroke. That is not the case for incident myocardial infarction (MI).

Having both gout and diabetes confers incremental risk for both incident MI and stroke compared with diabetes alone.

Researchers at the VA Medical Center, Birmingham, and the University of Alabama at Birmingham noted that gout is a known risk factor for cardiovascular disease, cardiovascular mortality, and all-cause mortality but that associations between gout and specific cardiovascular outcomes, MI, and stroke are unclear.

So they assessed whether gout is as strong a risk factor as diabetes for incident MI and incident stroke. They also wanted to estimate the increased cardiovascular risk with gout for women and men in various age groups and examine whether gout is additive to diabetes for cardiovascular risk.

They reported their findings in Arthritis Research & Therapy.

The study

The investigators used US claims data from 2007 to 2010 that included private and public health plans for their retrospective study. They identified 4 mutually exclusive cohorts: (1) diabetes only, (2) gout only, (3) gout and diabetes, and (4) neither gout nor diabetes. Patients with gout, diabetes, or both were slightly older and more likely to be men and rates of comorbidities were higher than in the cohort of patients who had neither condition.

Acute MI and stroke with hospitalization were the outcomes. The researchers compared the age- and sex-specific rates of incident MI and stroke across the 4 cohorts and assessed multivariable-adjusted hazard ratios (HRs).

Results

Some of the results:

• The incidence of acute MI was lowest in patients who had neither gout nor diabetes, followed by patients who had gout alone, diabetes alone, and both.

• Among men older than 80 years, the rates/1000 person-years for these cohorts were 14.6, 25.4, 27.7, and 37.4, respectively.

• Similar trends were noted for stroke and in women.

• Rates for MI and stroke increased with age in all 4 cohorts.

• Compared with diabetes only, gout was associated with a significantly lower adjusted HR of incident MI but a similar risk of stroke.

• HRs for incident MI and stroke were higher in patients who had both gout and diabetes compared with patients who had diabetes only.

Implications

• Recognition of gout as a cerebrovascular risk equivalent to diabetes implies that primary, secondary, and tertiary prevention of stroke may be needed in patients who have gout to reduce the increased risk.

• Screening for risk factors for stroke (hypertension, diabetes, hyperlipidemia) and aggressive treatment may be warranted in patients who have gout.

• Whether physicians may consider empiric use of lipid-lowering agents in a subgroup of patients with gout at high risk for cardiovascular events remains to be seen.

• Optimal treatment of gout that targets both hyperuricemia and systematic inflammation may be needed to reduce stroke risk in patients who have gout.

• To what extent each of these strategies reduces the risk of stroke in patients who have gout might be determined in large-sample observational studies or randomized trials of high-risk patients.

• Cardiovascular disease prevention and treatment strategies that are in place for patients with diabetes may be applicable to patients who have gout.

• By showing that gout is a cerebrovascular risk equivalent of diabetes for stroke, which is associated with high cardiovascular mortality, this study supports the previous finding that linked gout to higher overall mortality.

Conclusions

“As an inflammatory disease commonly associated with high comorbidity load (hypertension, diabetes, hyperlipidemia, obesity, renal failure) and systemic inflammation, gout can be effectively treated with inexpensive generic medications,” the authors stated.

“On the basis of our study results, the presence of gout should alert physicians to screen, diagnose, and promptly treat cardiovascular risk factors (hypertension, hyperlipidemia), similar to the approach used in patients with diabetes.”

References:

Singh JA, Ramachandaran R, Yu S, et al. “Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study.” Arthritis Res Ther. 2017 19: 228. https://doi.org/10.1186/s13075-017-1427-5.