A Prospective Study of Hyperuricemia on outy Arthritis and Mortality of Cardiovascular Disease
Date Issued
2009
Date
2009
Author(s)
Chen, Jiunn-Horng
Abstract
Objective. The association between the serum uric acid (sUA) level and the frequency of gout attack has been documented in epidemiologic reports. Gout was reported as a predisposing factor for cardiovascular disease (CVD) mortality. A relationship between sUA and CVD was thus speculated due to a strong association between sUA and gout. Although this association in high-risk groups has been documented, in general population it was yet undetermined. Besides, while we understand a definition of sUA level on hyperuricemia and gout diagnosis has been documented in the textbook, the prospective research to report a risk threshold of sUA for the occurrence of gout is still limited. Therefore the objectives of this study were aimed (1) to determine the risk of gout in relation to sUA levels and to find an optimal control level for gout prevention, and (2) to assess the temporal association between sUA level, hyperuricemia (sUA level >7 mg/dl), and mortality of all-cause and CVD in the general population.ethods. A prospective cohort study of the association between sUA and gout on >18 years old participants, and of the association between sUA and mortality on >35 years old subjects, was conducted using data from the MJ Health Screening Centers in Taiwan. The formal sub-study used outcome follow-up data from the National Health Insurance and the latter from the National Mortality Registry in Taiwan. In the formal, criteria for gout diagnosis consisted of (1) A-code or ICD-code of gout assigned during at least two visits to physicians or rheumatologists, and (2) simultaneous prescription of colchicine and urate-lowering drugs. Likewise, the risk of gout was estimated with respect to sUA levels. In the latter sub-study, mortality from all causes, total and respective CVD were compared according to increasing sUA levels. Cox proportional hazard model was used for analysis in both sub-studies which were approved either by the Institutional Review Board of Academia Sinica, Taipei, Taiwan, or by the Institutional Review Board of the China Medical University Hospital. The statistical software SAS version 9.01 (SAS Institute, Cary, NC) was used for analysis.esults. Data from 146,900 participants (67,954 men and 78,946 women) of MJ Health Screening Center from 1994 to 1996 were retrieved for analysis. In the formal sub-study on gout, there were a total of 132,556 individuals (60,181 men and 72,375 women) included in the analysis, with a mean follow-up of 7.31 years. Among them, 1,606 (1,341 men and 265 women) were diagnosed with gout. The standardized overall annual incidence of gout was 1.69 cases per 1,000 person-years. Using the receiver operating characteristic plot method to maximize sensitivity and specificity for predicting gout, the most appropriate sUA thresholds were 7.5 mg/dl for men and 6.0 mg/dl for women. Population-attributable risk analysis revealed that 85.4% of male and 85.2% of female incident gout were attributable to sUA levels
Subjects
serum uric acid
hyperuricemia
mortality
cardiovascular disease
gout.
SDGs
Type
thesis
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