Anti-gout Medications and Risk of Cardiovascular Disease: A Nested Case-Control Study

Impact of gout on cardiovascular disease mortality: a meta-analysis

BACKGROUND

Several epidemiological studies have suggested that gout patients have a higher risk of cardiovascular disease mortality than healthy people. In contrast, the association between gout and cardiovascular disease (CVD) mortality was not obvious in other studies. In the present study, we aimed to investigate the relative risk for CVD mortality in gout patients in comparison to healthy controls.

METHODS

Literature published before March 2023 was searched in Google Scholar, PubMed, and the Web of Science. We summarized the impact of gout on CVD mortality with a meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the impact of gout on CVD mortality were summarized with STATA 12.0 software.

RESULTS

Compared to individuals without gout, those with gout had higher mortality risks for CVD during follow-up, with a random effects model showing a risk of 1.30 (95% CI 1.15 to 1.48, p < 0.001; p-value for Cochran Q test < 0.001, I2 = 95.9%). Similarly, subjects with gout had a mortality risk of 1.28 (95% CI 1.12 to 1.46, p < 0.001; p-value for Cochran Q test = 0.050, I2 = 50.2%) for coronary heart disease (CHD) mortality during follow-up using the same statistical model. Furthermore, using a fixed effects model, individuals with gout had a mortality risk of 1.13 (95% CI 1.00 to 1.27, p = 0.049; p-value for Cochran Q test = 0.494, I2 = 0.0%) for myocardial infarction (MI) mortality during follow-up.

CONCLUSION

In conclusion, this meta-analysis provides evidence supporting a markedly increased mortality risk from CVD and CHD as well as MI in patients with gout relative to reference subjects without gout.

Association between gout and abdominal aortic aneurysm

BACKGROUND

Previous studies have shown an association between hyperuricemia and microvascular diseases, but the association between uric acid and abdominal aortic aneurysm (AAA) remains unclear. The aim of this study was to determine the relationship between gout and AAA.

METHODS

A population-based cohort study was conducted to validate the association between gout and AAA formation. The outcome in this study was the cumulative incidence of AAA in patients with or without gout during the 14-year follow-up period.

RESULTS

Our analysis included 121,236 patients with gout and 121,236 propensity score-matched controls from the National Health Insurance Research Database in Taiwan. Compared to the controls, patients who had gout exhibited a significantly increased incidence of AAA development [adjusted hazard ratio (HR) = 2.465, p < 0.001]. We also found that patients who were treated with anti-gout medications had a significantly lower risk of being diagnosed with an AAA than patients who were not treated with anti-gout medications (adjusted HR = 0.489, p < 0.001).

CONCLUSIONS

We have provided clinical evidence that gout is associated with the development of AAA.

Uric acid en route to gout

Gout and hyperuricemia (HU) have generated immense attention due to increased prevalence. Gout is a multifactorial metabolic and inflammatory disease that occurs when increased uric acid (UA) induce HU resulting in monosodium urate (MSU) crystal deposition in joints. However, gout pathogenesis does not always involve these events and HU does not always cause a gout flare. Treatment with UA-lowering therapeutics may not prevent or reduce the incidence of gout flare or gout-associated comorbidities. UA exhibits both pro- and anti-inflammation functions in gout pathogenesis. HU and gout share mechanistic and metabolic connections at a systematic level, as shown by studies on associated comorbidities. Recent studies on the interplay between UA, HU, MSU and gout as well as the development of HU and gout in association with metabolic syndromes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular, renal and cerebrovascular diseases are discussed. This review examines current and potential therapeutic regimens and illuminates the journey from disrupted UA to gout.