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Drivelegka P, Jacobsson LTH, Lindström U, Bengtsson K, Dehlin M. OP0192 INCIDENT GOUT AND RISK OF FIRST-TIME ACUTE CORONARY SYNDROME: A PROSPECTIVE, POPULATION-BASED, COHORT STUDY IN SWEDEN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Gout is associated with an increased risk of cardiovascular disease (CVD), but it is not clear whether this risk is intrinsic to gout itself or to underlying comorbidities. Although the impact of gout on CVD has been studied previously, the results have been conflicting and studies from European countries are scarce.Objectives:To investigate the risk of first-time acute coronary syndrome (ACS) in patients with incident gout in western Sweden, compared to the general population.Methods:Using data from the population-based health care database VEGA, we identified all patients with incident gout diagnosis at either primary or specialized health care units in western Sweden, in the period 2007– 2017 (20,287 cases; mean age, 65.6 years; 67.4% males). Cases regarded as incident, if they did not have any recorded diagnosis of gout in the previous seven years. For each case, up to five controls matched on age, sex, and county at the date of first gout diagnosis were identified from the census register (84,240 controls). Cases and controls with prior history of ischemic heart disease were excluded. The follow-up began at the first diagnosis of gout, and ended at the earliest of an ACS event, emigration, death, or 31 December 2017. To estimate the risk of first-time ACS, we used incident rate (IR) and univariable and multivariable Cox regression analysis with adjustments for the following cardiovascular risk factors: the diagnoses of hypertension, diabetes, hyperlipidemia, obesity, renal disease, heart failure, cardiomyopathy, psoriasis, chronic obstructive pulmonary disease, alcoholism, cancer, cerebrovascular, and atherosclerotic disease, as well as for the dispensed prescriptions of statins, anticoagulants, anti-hypertensive, anti-diabetic, anti-hyperlipidemic, anti-obesity, and vasodilator drugs.Results:The IR of first-time ACS was 9.0 events per 1,000 person-years in the gout cohort, compared to 6.3 in the control cohort. The IRs were lower for women than men, both in the gout (IR, 8.2 vs 9.4) and in the control cohort (IR, 5.0 vs 7.0). Univariable analysis showed that patients with gout have a higher risk of first-time ACS, as compared to the general population (Figure 1, Table 1), but the increased risk is largely diminished after adjustments for cardiovascular risk factors (Table 1).Table 1.Risk of first-time ACS in patients with incident gout, as compared to the general population.Unadjusted HR95% CIp-valueAdjusted HR95% CIp-valueACS Overall1.431.32-1.55<.00011.151.05-1.240.0013 Men1.351.23-1.48<.00011.121.02-1.230.0230 Women1.631.41-1.89<.00011.211.03-1.410.0207Figure 1.Event-free survival curve for patients with gout and controls during the follow-up, where event is first-time acute coronary syndrome.Conclusion:Patients with incident gout have a 43% higher risk of first-time ACS, as compared to the general population. This increased risk is largely explained by the increased occurrence of comorbidities in gout, but there is still a modestly increased risk that may be due to gout related factors. Our results underline the importance of cardiovascular risk assessment and the need for appropriate management of the underlying cardiovascular risk factors in patients with gout.Disclosure of Interests:None declared
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Landgren AJ, Jacobsson LTH, Lindström U, Sandström TZS, Drivelegka P, Björkman L, Fjellstedt E, Dehlin M. Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study. Arthritis Res Ther 2017; 19:173. [PMID: 28738835 PMCID: PMC5525359 DOI: 10.1186/s13075-017-1376-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. METHODS Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. RESULTS In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI:1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. CONCLUSIONS The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.
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Affiliation(s)
- A J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden.
| | - L T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - U Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - T Z S Sandström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - P Drivelegka
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - L Björkman
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
| | - E Fjellstedt
- Department of Nephrology and Transplantation, SUS University Hospital, Malmö, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, 405 30, Gothenburg, Sweden
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Drivelegka P, Jacobsson L, Sigurdardottir V, Svärd A, Dehlin M. THU0523 Comorbidity Pattern at The Time of Gout Diagnosis: A Population- and Register-Based Case-Control Study from Western Sweden. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0522 Increasing Incidence of Gout in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson L. THU0521 Prevalence of Gout and ULT Treatment in Western Sweden – A Register Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Drivelegka P, Papachrysos N, Petersson I, Bremander A, Jacobsson L. AB0717 Inflammatory Bowel Disease Associated Arthropathy: Characteristics of the Disease and Validity of Diagnoses Based on Icd-Coding in Sweden. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Drivelegka P, Papachrysos N, Petersson I, Bremander A, Jacobsson L. AB0716 Disease Severity as Measured by PROMS or Need for Second Line Treatment in Inflammatory Bowel Disease Associated Arthropathy: Comparison to Other Spondyloarthritis Subgroups. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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