Associations of Gout and Baseline Serum Urate Level With Cardiovascular Outcomes: Analysis of the Coronary Disease Cohort Study
Associations of Gout and Baseline Serum Urate Level With Cardiovascular Outcomes: Analysis of the Coronary Disease Cohort Study
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DOI：
10.1002/art.41007
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发表时间：
2019-08-29
影响因子：
13.3
通讯作者：
Richards, A. Mark
中科院分区：
文献类型：
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作者：
Stamp, Lisa K.;Frampton, Christopher;Richards, A. Mark
目的 确定痛风和血清尿酸 (SU) 水平是否与心血管疾病患者的死亡风险增加、任何心血管事件首次再入院时间或心力衰竭风险增加相关。方法 患有急性冠脉综合征 (ACS) 的个体被纳入冠心病队列研究。临床数据从入院时的医疗记录中收集，并在出院后收集临床、超声心动图和生化数据。痛风的定义是自我报告、使用降尿酸疗法或使用秋水仙碱，并根据病历审查有痛风证据。主要终点是全因死亡率、心脏缺血事件再入院时间和心力衰竭再入院时间。结果 可获得 1,514 名参与者的数据。在随访期间，160 名患有痛风的参与者中有 53 名（33.1%）死亡，1,354 名没有痛风的参与者中有 298 名（22.0%）死亡。对已知与死亡率相关的其他因素进行调整后，痛风特定的死亡风险没有增加（调整后的风险比为 0.98 [95% 置信区间 0.69-1.38]）。与没有痛风的患者相比，患有痛风的患者因心力衰竭再次入院的时间明显更短（调整后的风险比为 1.42 [95% 置信区间 1.02-1.97]）。无论参与者是否患有痛风，随着 SU 水平的升高，死亡和因心血管事件或心力衰竭再次入院的风险都会增加。结论 无论是否存在痛风，ACS 后的生存率相似。痛风患者因心力衰竭再次入院的风险增加，并且住院时间更长。这些事件的风险随着 SU 水平的增加而增加。
Objective To determine whether gout and serum urate (SU) levels are associated with increased risk of death, time to first readmission for any cardiovascular event, or incident heart failure in individuals with cardiovascular disease. Methods Individuals presenting with an acute coronary syndrome (ACS) were enrolled in the Coronary Disease Cohort Study. Clinical data were collected from the medical records at the index hospital admission, and clinical, echocardiographic, and biochemical data were collected postdischarge. Gout was defined by self-report, use of urate-lowering therapy, or use of colchicine with evidence of gout on review of the medical record. The primary end points were all-cause mortality, time to readmission for a cardiac ischemic event, and time to readmission for heart failure. Results Data from 1,514 participants were available. During the follow-up period, 53 of 160 participants with gout (33.1%) and 298 of 1,354 participants without gout (22.0%) died. After adjustment for other factors known to be associated with mortality, there was no gout-specific increase in risk of mortality (adjusted hazard ratio 0.98 [95% confidence interval 0.69-1.38]). Time to readmission for heart failure was significantly briefer in those with, compared to those without, gout (adjusted hazard ratio 1.42 [95% confidence interval 1.02-1.97]). Irrespective of whether a participant had gout or not, as SU level increased, there was an increased risk of death and readmission for either a cardiovascular event or heart failure. Conclusion Survival post-ACS is similar with and without the presence of gout. People with gout are at an increased risk of readmission for heart failure and have longer hospital stays. Risk of these events increases in parallel with increases in SU levels.