Ten-year cardiovascular risk changes and major adverse events in gout patients
Byeongzu Ghang1, Jinseok Kim1, Taeuk Kang2
1Division of Rheumatology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea.
Insights
Gout patients face increased risks of cardiovascular events like heart attack and stroke. Long-term changes in cardiovascular risk factors further elevate these risks, highlighting the need for comprehensive management.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Gout is linked to cardiovascular disease, but the combined impact of gout and evolving cardiovascular risk profiles on event risk remains unclear.
- Understanding this interaction is crucial for managing cardiovascular risk in gout patients.
Purpose of the Study:
- To investigate the association between gout and the long-term risk of cardiovascular events.
- To assess how long-term changes in cardiovascular risk profiles modify the risk of cardiovascular events in gout patients.
Main Methods:
- A nationwide cohort study utilized Korean National Health Insurance claims and screening data.
- Gout patients (N=113,853) and controls (N=1,138,530) were matched by age and sex.
- Cardiovascular risk profiles from 10 years prior to gout diagnosis and their changes were analyzed.
Main Results:
- Gout significantly increased the risk of myocardial infarction (HR 1.39), cerebral infarction (HR 1.36), cerebral hemorrhage (HR 1.50), and all-cause death (HR 1.07).
- Significant interactions were found between gout and long-term changes in diastolic blood pressure for myocardial and cerebral infarction.
- Interactions between gout and total cholesterol changes were noted for cerebral hemorrhage risk.
Conclusions:
- Gout patients exhibit a high risk of cardiovascular events, independent of baseline cardiovascular risk profiles and their long-term changes.
- Progressive changes in cardiovascular risk factors additively increase the risk of cardiovascular events in individuals with gout.
Objective:
The long-term interaction between cardiovascular (CV) risk profiles and gout may influence the risk of cardiovascular events. However, the impact of gout and long-term changes in CV risk profile on CV events is unclear.
Methods:
This was a nationwide cohort study based on the Korean National Health Insurance claims database and the National Health Screening Program. Patients aged 20-90 years newly diagnosed with gout after January 2012 and age- and sex-matched controls without gout were included. After adjusting for CV risk profiles measured 10 years before gout diagnosis and their long-term changes, the relative risks of incident CV events (myocardial infarction, cerebral infarction and cerebral haemorrhage) and all-cause death in the gout patients were assessed.
Results:
In total, 113 853 patients with gout and 1 138 530 matched controls were studied. Multivariable analysis showed that gout was associated with increased risks for myocardial infarction (hazard ratio [HR]: 1.39, P < 0.001), cerebral infarction (HR: 1.36, P < 0.001), cerebral haemorrhage (HR: 1.50, P < 0.001), and all-cause death (HR: 1.07, P = 0.004). In addition, significant interactions were observed for myocardial infarction (Grade 1 aggravation over 10 years of diastolic blood pressure [DBP], P = 0.042), cerebral infarction (Grade 2 aggravation over 10 years of DBP, P = 0.037) and cerebral haemorrhage (Grade 2 aggravation over 10 years of total cholesterol, P = 0.057).
Conclusions:
Gout patients had a high risk of incident CV events even after adjusting for CV risk profiles and their long-term changes. These long-term changes additively increase the risk of CV events in gout patients.
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