Gout Increases Risk Of Heart Attack, According To University Of
Pittsburgh Study
Article Date: 07 Aug 2006 - 1:00am (PST)
People with gout are at increased risk of having a heart attack,
according to a University of Pittsburgh School of Medicine study
published in the August edition of the journal Arthritis &
Rheumatism. The article is available on line at
http://www3.interscience.wiley.com/cgi-bin/jhome/76509746. This
is the first study to show that among men with no previous history
of coronary artery disease, gout is a significant independent risk
factor of heart attack.
Gout is a metabolic disease marked by acute arthritis and
inflammation of the joints, usually beginning in the knee or foot.
It is caused by hyperuricemia, a build up of uric acid in blood.
When chronic or severe hyperuricemia leads to urate crystals within
joints, it results in an inflammatory response that manifests as
gouty arthritis.
"Our study confirms that gouty arthritis is an independent risk
factor for myocardial infarction (MI) or heart attack. Until now
this relationship has not been explained by well-known links to
renal function, metabolic syndrome, diuretic use and the traditional
cardiovascular risk factors," said Eswar Krishnan, M.D., assistant
professor of medicine at the University of Pittsburgh School of
Medicine, division of rheumatology, and principal author of the
study.
The prospective study examined data from 12,866 men who were
enrolled for a mean of 6.5 years in the Multiple Risk Factor
Intervention Trial (MRFIT), a randomized primary cardiovascular
disease prevention trial conducted and supported by the National
Heart, Lung and Blood Institute.
There were 5,337 men with hyperuricemia at the beginning of the
study. Over the study period, 1,123 individuals developed gouty
arthritis. There was no statistically significant difference between
the groups with regard to cholesterol levels, aspirin use, family
history of acute MI, or diabetes mellitus. However, the group with
gout was significantly more likely to have used diuretics and
alcohol. Modest yet statistically significant elevations of blood
pressure, age, blood glucose and body mass index were observed in
the gout group. Subjects in the group with gout were less likely to
be current smokers than were those in the group without gout.
During the course of the study, 1,108 events of acute MI occurred in
the group with gout (10.5 percent) and 990 events in the group
without gout (8.43 percent). Of the 1,108 MIs, 246 were fatal.
The study also found a relationship between gout and the risk of
acute MI to be present among nonusers of alcohol, diuretics or
aspirin and among those who did not have metabolic syndrome,
diabetes mellitus or obesity.
"The absolute magnitude of the relative risk for the presence of
gout was not high. Yet, the odds ratio associated with gout was
relatively high compared to other risk factors in this study," Dr.
Krishnan said. "For acute MI to occur, an environment that promotes
atherogenesis and thrombogenesis is needed. Hyperuricemia is well
known to be an independent risk factor for atherosclerotic diseases
in general and since chronic hyperuricemia is strongly associated
with gout, it is not very surprising that an independent coronary
risk for the presence of both hyperuricemia and gout was observed."
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This study was supported by an unrestricted grant from TAP
Pharmaceutical Products Inc. of Lake Forest, Il. This was an
investigator-initiated project, and TAP Pharmaceutical Products Inc.
was not involved in the design, data collection, or analysis and
interpretation of the data.
Contact: Frank Raczkiewicz
University of
Pittsburgh Medical Center