Short-Term Risk of Cardiovascular Events in People Newly Diagnosed With Gout
Edoardo Cipolletta1, Georgina Nakafero2, Pascal Richette3
1University of Nottingham, Nottingham, United Kingdom, and Polytechnic University of Marche, Ancona, Italy.
Insights
The first diagnosis of gout is linked to a short-term increase in cardiovascular events. This heightened risk for myocardial infarction, stroke, and transient ischemic attack is most significant in the 30 days post-diagnosis.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Gout, a form of inflammatory arthritis, is associated with an increased risk of cardiovascular disease.
- The immediate temporal relationship between gout diagnosis and cardiovascular events requires further investigation.
Purpose of the Study:
- To examine the short-term association between the initial diagnosis of gout and the occurrence of cardiovascular events.
Main Methods:
- A self-controlled case series and a cohort study were conducted using UK primary care, hospitalization, and mortality data (1997-2020).
- Individuals diagnosed with gout were analyzed for cardiovascular events (myocardial infarction, stroke, transient ischemic attack) within 30 days of diagnosis compared to baseline or later periods.
Main Results:
- A total of 4,398 patients were included in the case series, with a significantly higher incidence rate ratio (1.55) for cardiovascular events in the 30 days post-gout diagnosis.
- In the cohort study of 76,440 patients, cardiovascular event incidence was 31.2 per 1,000 person-years in the first 30 days post-diagnosis, compared to 21.6 per 1,000 person-years between days 31-730.
Conclusions:
- The first diagnosis of gout is associated with a short-term increase in the risk of cardiovascular events.
- This heightened risk is particularly notable within the 30 days following the initial gout diagnosis consultation.
Objective:
To investigate the temporal association between the first diagnosis of gout and cardiovascular events in the short term.
Methods:
We performed a self-controlled case series analysis and a cohort study using data from linked primary care, hospitalization, and mortality records from the United Kingdom's Clinical Practice Research Database-GOLD. We included individuals with a new diagnosis of gout either in the primary care or secondary care between January 1, 1997 and December 31, 2020. The first consultation at which gout was diagnosed was the exposure of interest. The main outcome consisted of cardiovascular events (ie, a composite of fatal and nonfatal myocardial infarction, ischemic or hemorrhagic stroke, and transient ischemic attack).
Results:
The 4,398 patients (66.9% male, mean age 74.6 years) had a cardiovascular event within at least two years of their first recorded diagnosis of gout. The incidence of cardiovascular events was significantly higher in the 30 days after the first diagnosis of gout compared to baseline (adjusted incidence rate ratio 1.55, 95% confidence interval [CI] 1.33-1.83). Among 76,440 patients (72.9% male, mean age 63.2 years) included in the cohort study, the incidence of cardiovascular events in the 30 days after the first gout diagnosis (31.2 events per 1,000 person-years, 95% CI 27.1-35.9) was significantly higher than in days 31 to 730 after gout diagnosis (21.6 events per 1,000 person-years, 95% CI 20.8-22.4) with a rate difference of -9.6 events per 1,000 person-years (95% CI -14.0 to -5.1).
Conclusion:
Individuals had a short-term increased risk of cardiovascular events in the 30 days following the first consultation at which gout was diagnosed.
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