Risk Factors for Gout Among Women

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DESCRIPTION (provided by applicant): Gout is a common and excruciatingly painful inflammatory arthritis associated with hyperuricemia. The condition represents an important type of arthritis that may be substantially controlled through dietary and life-style modifications. Despite the doubling of the incidence of gout among women over the past 20 years and the substantial prevalence particularly in the aging female population, the risk factors for gout among women remain unknown. Recently, we clarified the role of conventionally suspected dietary and other factors on the risk of gout among men in a large prospective study. However, given the important gender differences in uric acid metabolism, the role of sex hormones, and the frequency of gout, the risk factors for gout may vary considerably between sexes. We propose to build upon our previous work on gout among men to comprehensively extend our prospective investigation of risk factors for gout specifically among women in the Nurses' Health Study (n = 121,700). First, we will prospectively investigate the hypothesized relations between conventionally suspected risk factors and the risk of incident gout: 1) increased risk with adiposity, weight gain, intake of meat, seafood, and alcohol [beer and liquor, but not wine], hypertension, and diuretic use; 2) decreased risk with weight loss and dairy intake; and 3) decreased risk with postmenopausal hormone use. Second, we will examine the relations with novel risk factors of gout: 1) increased risk with sugar-sweetened soft drinks and fructose consumption; 2) decreased risk with coffee intake; and 3) decreased risk with vitamin C consumption. During the proposed 2-year study period, we will continue to confirm incident cases of gout according to the American College of Rheumatology (ACR) survey gout criteria. Our primary analysis will involve multivariate modeling to examine independent associations between these potential risk factors and the incidence of gout among women. The significance and strengths of the current proposal include: 1) relevance to the pressing disease burden of a common rheumatic condition (i.e. important prophylactic options for female gout), 2) our experience in gout research, 3) large sample size providing high precision and power for the proposed estimates, 4) prospective incident outcome analysis, and 5) cost-efficient study design using well-established, validated data. This study will provide unique, population-based, prospective data about common modifiable risk factors for gout specifically among women. These aims will fill important gaps in our knowledge of female gout, a common and excruciatingly painful condition with a growing disease burden. PUBLIC HEALTH RELEVANCE: Despite a doubling of the rate of new gout cases among women over the past 20 years, and its substantial disease burden, particularly in the aging female population, the risk factors for gout among women remain unknown. Because of the role of estrogen on uric acid metabolism and the marked differences in disease frequency between men and women, the risk factors for gout may vary considerably between sexes. This study will build upon our previous work on gout among men to comprehensively extend our investigation of risk factors for gout specifically among women in the Nurses' Health Study.