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Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction
Eswar Krishnan1, Bhavik J Pandya, Bharathi Lingala
1Department of Medicine, Stanford University School of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, CA 94304, USA. e.krishnan@stanford.edu
Insights
High serum urate (sUA) levels and untreated gout are linked to increased mortality risk in patients with myocardial infarction (MI). These findings suggest sUA and gout status can serve as important prognostic markers for cardiovascular outcomes.
Area of Science:
- Cardiovascular Medicine
- Clinical Biomarkers
- Epidemiology
Background:
- Patients with myocardial infarction (MI) face risks of recurrent events and mortality.
- Prognostic markers are crucial for identifying high-risk individuals post-MI.
- Hyperuricemia, indicated by elevated serum urate (sUA), is linked to coronary heart disease (CHD) but its prognostic role post-MI is unclear.
Purpose of the Study:
- To investigate whether serum urate (sUA) levels predict adverse cardiovascular outcomes in patients with a history of MI.
- To assess hyperuricemia as a potential prognostic biomarker for CHD events and mortality in the post-MI population.
Main Methods:
- Post hoc analysis of the Aspirin Myocardial Infarction Study, a randomized clinical trial involving patients with documented MI.
- Evaluation of all-cause death, CHD mortality, coronary incidence, and stroke based on baseline serum urate (sUA) quartiles.
- Sub-analysis examining the impact of gouty arthritis (treated vs. untreated) on outcomes.
Main Results:
- Elevated serum urate (sUA) levels, particularly in the highest quartile, were associated with significantly increased risks for all-cause mortality (HR 1.88), CHD mortality (HR 1.99), and coronary incidence (HR 1.36).
- Participants with untreated gout demonstrated a 1.5 to 2.0-fold increased hazard for adverse outcomes.
- Treated gout was not associated with this heightened risk, suggesting treatment mitigates the prognostic impact.
Conclusions:
- Serum urate (sUA) levels may serve as an independent prognostic marker for adverse cardiovascular outcomes in patients post-MI.
- Untreated gout is also identified as a significant independent risk factor for poor prognosis in this patient group.
- These findings highlight the importance of monitoring sUA and managing gout in patients with a history of MI.
Introduction:
Patients with a history of myocardial infarction (MI) are often at risk for complications, including subsequent MI and death. Use of prognostic markers may aid in preventing these poor outcomes. Hyperuricemia is associated with increased risk for coronary heart disease (CHD) and/or mortality; however, it is unknown if serum urate (sUA) levels predict outcomes in patients with previous MI. The purpose of this study was to assess hyperuricemia as a biomarker of CHD outcomes in such patients.
Methods:
These were post hoc analyses of datasets from the Aspirin Myocardial Infarction Study, a 1:1 randomized, double-blind clinical trial, conducted from 1975 to 1979, that examined mortality rates following daily aspirin administration over three years in individuals with documented MI. The primary outcome measures were all-cause death, CHD mortality, coronary incidence, and stroke by quartile of baseline sUA. A sub-analysis of all outcome measures in the presence or absence of gouty arthritis was also performed.
Results:
Of 4,524 enrolled participants, data on 4,352 were analyzed here. All outcomes were greatest for patients in the fourth sUA quartile. In multivariate regression models, the hazard ratios (HR) for patients in the highest quartile were 1.88 for all-cause mortality (95% confidence interval (CI), 1.45 to 2.46), 1.99 for CHD mortality (95% CI, 1.49 to 2.66), and 1.36 for coronary incidence (95% CI, 1.08 to 1.70). Participants with untreated gout had an adjusted hazard ratio ranging from 1.5 to 2.0 (all P < 0.01) for these outcomes. Participants with gout who were receiving treatment did not exhibit this additional risk.
Conclusions:
sUA and untreated gout may be independent prognostic markers for poor all-cause and CHD mortality in patients with recent acute MI.
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