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Gout as a risk factor for acute myocardial infarction: evidence from competing risk model analysis
Chia-Luen Huang1, Tai-Wen Wang2, Yong-Chen Chen3
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan.
Insights
Gout patients face a higher risk of acute myocardial infarction (AMI), particularly those without other cardiovascular conditions. This study highlights gout as a significant factor in heart attack risk.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- Chronic inflammation in gout is linked to atherosclerosis.
- Previous epidemiological studies on gout and acute myocardial infarction (AMI) risk have yielded inconclusive results.
Purpose of the Study:
- To investigate the association between gout and the risk of incident acute myocardial infarction (AMI).
- To analyze how comorbidities influence the relationship between gout and AMI risk.
Main Methods:
- Retrospective cohort study using Taiwan's National Health Insurance Research Database (2000-2013).
- Compared 3581 gout patients with 14,324 non-gout controls.
- Utilized the Lunn-McNeil competing risk model to calculate cause-specific hazard ratios (HRs).
Main Results:
- The cumulative incidence of AMI was significantly higher in the gout cohort (adjusted HR=1.36).
- Gout patients without hypertension, diabetes, or hyperlipidemia showed a markedly higher AMI risk (HRs 1.63-2.09) compared to those with these comorbidities (HRs 0.95-1.13).
Conclusions:
- Gout is associated with an increased risk of acute myocardial infarction (AMI).
- The cardiovascular risk posed by gout is influenced by the presence of other comorbidities, suggesting a complex interplay in disease pathogenesis.
Abstract:
Chronic inflammation, a hallmark of gout, is implicated in the pathogenesis of atherosclerosis. Thus, in theory, gout can be expected to increase the risk of acute myocardial infarction (AMI). Yet, results from several epidemiological studies have been inconclusive. A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohort comprised 3581 patients with gout (the gout cohort) and 14,324 patients without gout (the non-gout cohort). The primary outcome was the incidence of AMI. To estimate the effect of gout on the risk of AMI, the Lunn-McNeil competing risk model was fitted to estimate cause-specific hazard ratios (HRs) and their 95% confidence intervals (CIs). The cumulative incidence of AMI was significantly higher in the gout cohort than in the non-gout cohort, resulting in an adjusted HR of 1.36 (95% CI 1.04 to 2.76). Further, HRs of gout with incident AMI were higher in patients without hypertension, diabetes mellitus, or hyperlipidemia (ranging from 1.63 to 2.09) than in those with each of these comorbidities (ranging from 0.95 to 1.13). The results of this study suggest that patients with gout have an increased risk of AMI. The AMI risk associated with gout was conditional on patients' cardiovascular risk profile. Future work is needed to confirm these findings.
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