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Stroke Risk in Patients with Gout: A Nationwide Retrospective Cohort Study in Taiwan
Ping-Han Tsai1, Chang-Fu Kuo2,3,4, Lai-Chu See2,5,6
1Division of Rheumatology, Allergy and Immunology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan.
Insights
Patients with gout in Taiwan initially had a lower risk of stroke, but this risk significantly increased after three years for both ischemic and hemorrhagic stroke types. This highlights a long-term increased stroke risk associated with gout.
Area of Science:
- Epidemiology
- Cardiovascular Health
- Rheumatology
Background:
- Gout is a common inflammatory arthritis.
- Stroke is a leading cause of disability and mortality worldwide.
- Understanding the relationship between gout and stroke risk is crucial for patient management.
Purpose of the Study:
- To investigate the long-term risk of stroke in Taiwanese patients diagnosed with gout.
- To differentiate risks for ischemic and hemorrhagic stroke subtypes.
Main Methods:
- A large cohort study using the Taiwan National Health Insurance Database (2000-2018).
- Propensity score matching was employed to compare gout patients with a matched control group (n=310,820 each).
- Incidence rates and hazard ratios for stroke were calculated and analyzed over time.
Main Results:
- Initially, gout patients showed lower risks of both ischemic and hemorrhagic stroke within the first three years.
- After three years, gout patients exhibited significantly higher risks for both ischemic stroke (HR: 1.08) and hemorrhagic stroke (HR: 1.14).
- Incidence rates for both stroke types increased in the gout group compared to controls after the three-year mark.
Conclusions:
- Gout patients in Taiwan face an elevated risk of both ischemic and hemorrhagic stroke beyond the initial three years post-diagnosis.
- The findings suggest a need for proactive cardiovascular risk management in gout patients.
- Long-term monitoring and preventive strategies are recommended for individuals with gout.
Objectives:
To estimate stroke risk in Taiwanese patients with gout.
Methods:
We enrolled patients from the Taiwan National Health Insurance Database, with gout diagnosed from 2000 to 2008, and followed them up until December 2018. This cohort was propensity score-matched according to birth year, sex, the date of diagnosis of gout, comorbidities, and co-medications with individuals without gout (controls) (n = 310,820 in each group). Stroke was defined as the primary diagnosis at discharge after the index date. To evaluate ischemic and hemorrhagic stroke risks, we calculated their incidence, hazard ratio (HR), and two-year moving average incidence rate.
Results:
The incidence (95% CI) and HR of ischemic stroke were lower in the gout group than in the control group in the first 3 years (incidence: 4.74 [4.60-4.88] vs. 5.17 [5.03-5.32] per 1000 person-years; HR: 0.92 [0.88-0.96]), then became significantly higher than in the control group after 3 years (incidence: 4.10 [4.04-4.16] vs. 3.81 [3.75-3.87] per 1000 person-years; HR: 1.08 [1.05-1.10]). Similarly, the incidence (95% CI) and HR of hemorrhagic stroke was lower in the gout group than in the control group in the first 3 years (incidence: 1.51 [1.43-1.59] vs. 1.70 [1.62-1.79] per 1000 person-years; HR: 0.88 [0.82-0.92]), then became significantly higher than in controls after 3 years (incidence: 1.43 [1.39-1.46] vs. 1.26 [1.22-1.29] per 1000 person-years; HR: 1.14 [1.10-1.18]).
Conclusions:
In Taiwan, patients with gout had higher risks of ischemic and hemorrhagic stroke after 3 years.
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