In a recent study it has been found that Gout is a risk equivalent to diabetes for incident stroke. That is not the case for incident myocardial infarction (MI).Having both gout and diabetes confers incremental risk for both incident MI and stroke compared with diabetes alone.These findings have been published in Arthritis Research & Therapy.
VA Medical Center, Birmingham, and the University of Alabama at Birmingham noted that gout is a known risk factor for cardiovascular disease, cardiovascular mortality, and all-cause mortality but that associations between gout and specific cardiovascular outcomes, MI, and stroke are unclear.Therefore they assessed whether gout is as strong a risk factor as diabetes for incident MI and incident stroke. They also wanted to estimate the increased cardiovascular risk with gout for women and men in various age groups and examine whether gout is additive to diabetes for cardiovascular risk.
investigators used US claims data from 2007 to 2010 that included private and public health plans for their retrospective study. They identified 4 mutually exclusive cohorts: (1) diabetes only, (2) gout only, (3) gout and diabetes, and (4) neither gout nor diabetes. Patients with gout, diabetes, or both were slightly older and more likely to be men and rates of comorbidities were higher than in the cohort of patients who had neither condition.
Acute MI and stroke with hospitalization were the outcomes. The researchers compared the age- and sex-specific rates of incident MI and stroke across the 4 cohorts and assessed multivariable-adjusted hazard ratios (HRs).
It was found that
- The incidence of acute MI was lowest in patients who had neither gout nor diabetes, followed by patients who had gout alone, diabetes alone, and both.
- Among men older than 80 years, the rates/1000 person-years for these cohorts were 14.6, 25.4, 27.7, and 37.4, respectively.
- Similar trends were noted for stroke and in women.
- Rates for MI and stroke increased with age in all 4 cohorts.
- Compared with diabetes only, gout was associated with a significantly lower adjusted HR of incident MI but a similar risk of stroke.
The findings implied that in patients of gout primary, secondary, and tertiary prevention of stroke may be needed in to reduce the increased risk.In addition to this screening for risk factors for stroke (hypertension, diabetes, hyperlipidemia) and aggressive treatment may be warranted in patients who have gout. The patients of gout may be subjected to the optimal treatment of gout targeting both hyperuricemia and systematic inflammation to reduce stroke risk in patients who have gout.
It was concluded that Gout is a risk equivalent to DM for incident stroke but not for incident MI. Having both gout and DM confers incremental risk compared with DM alone for both incident MI and stroke
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Dr. Kamal Kant Kohli
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