Abdominal aortic aneurysm and gout risk: A nationwide population-based observational cohort study

Abdominal aortic aneurysm (AAA) is associated with systemic inflammatory processes that may influence metabolic disorders. This study investigated whether AAA is a risk factor for gout development and evaluated how different treatment approaches influence this risk. We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database (2009-2015). We identified 14,256 newly diagnosed patients with AAA and matched them with 42,768 non-AAA controls at a 1:3 ratio based on age and sex. Participants were followed until December 31, 2019, with incident gout (International Classification of Diseases, 10th revision, M10) as the primary endpoint. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). During the median follow-up of 6.3 years, the incidence of gout was significantly higher in AAA patients than in controls (21.75 vs 13.87 per 1000 person-years). After comprehensive adjustment for demographic, clinical, and lifestyle factors, AAA remained independently associated with increased gout risk (HR: 1.443, 95% CI: 1.325-1.573, P < .001). AAA patients who underwent surgical intervention had a significantly higher risk of developing gout (HR: 1.795, 95% CI: 1.583-2.035, P < .001) compared to non-AAA controls. Among surgical approaches, endovascular aneurysm repair (EVAR) was associated with a higher risk of gout (HR: 1.862, 95% CI: 1.616-2.146, P < .001) than open surgical aneurysm repair (OSAR) (HR: 1.658, 95% CI: 1.363-2.018, P < .001). AAA is an independent risk factor for gout development, with surgical intervention further increasing this risk, particularly following EVAR procedures. These findings have important implications for metabolic monitoring in AAA patients, especially those undergoing endovascular interventions.