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Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study
Jasvinder A Singh1,2,3,4, Rekha Ramachandaran5, Shaohua Yu6
1Medicine Service, VA Medical Center, 700 South 19th Street, Birmingham, AL, 35233, USA. jasvinder.md@gmail.com.
Insights
Gout poses a similar stroke risk as diabetes mellitus (DM), but a lower myocardial infarction (MI) risk. Combining gout and DM increases risks for both MI and stroke.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Gout is a known cardiovascular disease risk factor, but its specific impact on myocardial infarction (MI) and stroke requires clarification.
- Understanding the comparative risk of gout versus diabetes mellitus (DM) for cardiovascular events is crucial for patient management.
Purpose of the Study:
- To determine if gout is as significant a risk factor as DM for incident MI and stroke.
- To compare the cardiovascular risk associated with gout, DM, and their coexistence.
Main Methods:
- Retrospective analysis of U.S. claims data (2007-2010) involving four cohorts: DM only, gout only, gout and DM, and neither condition.
- Outcomes assessed were hospitalization for acute MI or stroke.
- Multivariable-adjusted hazard ratios (HRs) were calculated to compare risks across cohorts.
Main Results:
- Patients with gout alone showed a lower risk of MI compared to DM alone (HR 0.81) but a similar risk of stroke (HR 1.02).
- Individuals with both gout and DM had significantly higher risks for both MI (HR 1.35) and stroke (HR 1.42) compared to those with DM alone.
- Trends were consistent across different age groups and sexes.
Conclusions:
- Gout presents a risk equivalent to DM for incident stroke, but not for incident MI.
- The coexistence of gout and DM confers an additive risk for both MI and stroke beyond that of DM alone.
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.