Gout and coronary heart disease: the Framingham Study
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R D Abbott1, F N Brand, W B Kannel
1Statistical Resource Section, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.
Insights
Gout not linked to diuretics significantly increases coronary heart disease risk in men by 60%. This association, particularly for angina pectoris, persists even after accounting for other cardiovascular risk factors.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Gout is a common inflammatory arthritis.
- The link between gout and cardiovascular disease is debated, especially when diuretics are not involved.
- Understanding gout's independent impact on heart health is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between gout, independent of diuretic use, and the incidence of coronary heart disease (CHD).
- To determine if gout is an independent risk factor for CHD in men and women.
- To assess the influence of traditional cardiovascular risk factors on the gout-CHD association.
Main Methods:
- Analysis of 32-year follow-up data from 5209 participants in the Framingham Study.
- Examining the incidence of gout and coronary heart disease.
- Statistical analysis to compare CHD rates in individuals with and without gout, controlling for potential confounders.
Main Results:
- Gout incidence was significantly higher in men (3.2/1000) than women (0.5/1000).
- Men with gout (not using diuretics) had a 60% excess risk of CHD, including a two-fold excess of angina pectoris.
- This association in men remained significant after adjusting for systolic blood pressure, cholesterol, alcohol intake, BMI, and diabetes.
- No significant association between gout and CHD was observed in women.
Conclusions:
- Gout, when not associated with diuretic use, represents an independent risk factor for coronary heart disease in men.
- The increased CHD risk in men with gout is not explained by common clinical risk factors.
- Further research may be needed to elucidate the mechanisms underlying this association in men.
Abstract:
The relationship between gout, not associated with the use of diuretics, and the development of coronary heart disease was examined in 5209 subjects originally enrolled in the Framingham Study. Based on 32 years of follow-up, the two year incidence of gout was six times greater in men (3.2/1000) as compared to women (0.5/1000). For both sexes, the incidence of gout showed no clear relationship with age. Among men who never received diuretics, those afflicted by gout, as compared to those without gout, experienced a 60% excess of coronary heart disease (95% confidence limits, 1.1-2.2), primarily attributed to a two fold excess of angina pectoris (95% confidence limits, 1.2-3.1). Although gout was usually associated with other atherogenic risk factors, control of systolic blood pressure, total cholesterol, alcohol intake, body mass index, and diabetes failed to alter the effect of gout on the preceding coronary events in men. For women, there were no significant associations between gout and coronary heart disease. We conclude that gout, unrelated to the intake of diuretics, imparts an additional risk of coronary heart disease in men, unexplained by clinically measured risk factors.