Gout linked to greater risk for heart failure among older adults
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Gout is associated with an increased risk for heart failure among adults aged 65.5 years and older, according to data published in Arthritis Research & Therapy.
“Gout is a disease that is common in older adults and consists of episodes of inflammation in joints and other tissues,” Lisandro D. Colantonio, MD, PhD, of the University of Alabama at Birmingham, told Healio Rheumatology. “It is common that older adults also have cardiovascular disease, like heart attack, stroke or heart failure.”
To analyze the link between gout and heart failure, as well as other heart conditions, Colantonio and colleagues studied data from the population-based Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. The researchers analyzed data on a total of 5,713 black and white men and women, aged 65.5 years and older, with Medicare coverage and without a history of heart failure, chronic heart disease or stroke at baseline between 2003 and 2007. Participants, the mean baseline age was 72.6 years, 44.9% were men, 31.4 were black and 3.3% had gout.
Colantonio and colleagues defined gout as at least one hospitalization, or at least two outpatient visits, with a gout diagnosis code in the Medicare claims data prior to each participant’s baseline examination. All participants in the REGARDS study were followed for heart failure hospitalization, as well as for chronic heart disease, stroke and all-cause mortality through Dec. 31, 2016. Further, analyses were replicated in a random sample of 839,059 patients aged65.5years or older with Medicare coverage between Jan. 1, 2008, and June 30, 2015. These patients were followed through Dec. 31, 2017.
According to the researchers, during a median follow-up of 10 years, the incidence rates per 1,000 person-years among participants with and without gout were 13.1 and 4.4 for heart failure hospitalization, 16 and 9.3 for chronic heart disease, 9.3 and 8.2 for stroke, and 55 and 37.1 for all-cause mortality, respectively. After adjusting for sociodemographic variables and cardiovascular risk factors, hazard ratios comparing those with gout to those without were 1.97 (95% CI, 1.22-3.19) for heart failure hospitalization, 1.21 (95% CI, 0.79-1.84) for chronic heart disease, 0.83 (95% CI, 0.48-1.43) for stroke, and 1.08 (95% CI, 0.86-1.35) for all-cause mortality.
“In our study, we compared older adults with and without gout and found no differences in their risk of having a heart attack or stroke,” Colantonio said. “However, we found that older adults with gout were more likely to develop heart failure compared to those without gout. This higher risk of having heart failure was present in black and white adults with gout, and in men and women.”
“Based on these results, it is important that older adults with gout receive medical advice about their risk of having heart failure and how to lower it,” he added. “Also, clinicians should follow their older patients with gout for initial signs of heart failure as these may need medical treatment.”
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David A. McLain, MD, FACP, FACR
In this study, Colantonio and colleagues mined the REGARDS cohort study database for patients with gout, selecting those over 65.5 years old who had Medicare but without a diagnosis of congestive heart failure (HF), coronary heart disease (CHD) or stroke. They then compared patients with gout against patients without gout from this cohort.
The authors determined that patients with gout were older, more likely to be black or men, have less than a high school education, higher BMI or low physical activity, higher levels of systolic blood pressure or C-reactive protein, and maintained a Southern dietary pattern associated with diabetes and chronic kidney disease.
Additionally, patients with gout were more likely to be on anti-hypertensives and COX-2 selective NSAIDs, and exhibited higher unadjusted cumulative incidence of HF hospitalization, CHD and all-cause mortality. Although the incidence of stroke was similar between the two groups, after multivariate analysis, only the risk of heart failure admission was higher among patients with gout.
The authors also discuss the association of the overexpression of IL-1 in animal models with the development of HF with preserved left ventricular ejection fraction. We know that IL-1 is an important inflammatory cytokine in gout; canakinumab was shown in the CANTOS trial to decrease HF admission in those with prior myocardial infarction and elevated CRP. Other factors include insulin resistance — seen in gout — and HF and hyperuricemia itself, which was associated with incident HF in the Cardiovascular Health Study. Finally, the fact that studies show a correlation of gout to CHD and stroke in younger individuals, but not in this older group, may be attenuation of the effects at an older age.
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