Long-term Cardiovascular Mortality Among Middle-aged Men With Gout

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Abstract
Gouty arthritis (gout) is a common arthritic condition characterized by chronic hyperuricemia with periods of intense inflammatory flares and deposition of monosodium urate crystals in joints and extra-articular tissues. Hyperuricemia is a condition associated with adverse cardiovascular disease (CVD) outcomes1,2 in its own right. People with gout have chronic and sometimes severe hyperuricemia and additionally experience intense inflammatory episodes. The Framingham Heart Study Group found an association between gout, unrelated to diuretic use, and coronary heart disease, primarily angina pectoris. During the intervention phase of the Multiple Risk Factor Intervention Trial (MRFIT), gout was associated with an increased risk of nonfatal acute myocardial infarction (MI) but not with an increased risk of fatal acute MI.3,4 Some of the other studies that attempted to evaluate the association between gout and CVD were too small,5,6 lacked uric acid information,6 selected inappropriate controls,7 or used administrative data with limited data on other CVD risk factors.8 Among larger studies with some form of diagnostic validation, a large study from Taiwan reported a relationship between gout and electrocardiographic evidence of MI.9 The Health Professionals Study reported significant cardiovascular mortality risk for patients with gout; however, information on serum uric acid levels was not studied in that report.10 The present study was undertaken to address the gout-CVD link and to assess the role of hyperuricemia in this link.