Background/Purpose: The focus of this project is to assess the contribution of hyperuricemia and gout to the risk for cardiovascular events. In a preliminary analysis we examined known characteristics of the metabolic syndrome in vascular events. Of the five metabolic syndrome indicators, hypertension, hyperglycemia, dyslipidemia, obesity and elevated triglycerides, each has been shown to increase the risk for experiencing cardiac events (heart attack or stroke). There has yet to be an investigation, however, assessing whether or not these indicators are additive or synergistic in their contribution to the risk for experiencing a cardiac event and their relationship to hyperuricemia and gout.

Methods: Using the NHANES III data set (1988-1994), we conducted a cross-sectional analysis to assess whether or not the five facets of the metabolic syndrome are additive or synergistic in contributing to the risk for experiencing a cardiac event (defined as either a heart attack or stroke). To do so, we used interaction terms in a multiple logistic regression model, controlling for age, sex, race/ethnicity, education, smoking status, exercise, gout diagnosis and serum uric acid levels. Synergy was assessed based on statistical significance of interaction term odds ratios (ORs).

Results: Among all of the interaction terms, only the interaction between all five metabolic syndrome facets was statistically significant (OR = 240.06, 95% CI: 1.73; 33,304.89, p = 0.030), indicative of a synergistic effect.  All other ORs had p-values ≥ 0.060. It is important to note that both ORs for the interaction terms of four of the five indicators had p-values of 0.060 and 0.067, while all other ORs were > 0.1. In this dataset hyperuricemia and gout did contribute additional risk (Hyperuricemia OR 1.11), p-value:0.036, 95%, CI: 1.01, 2.22. Gout OR 2.20 (p-value:0.001, 95% CI: 1.39, 3.49).

Conclusion: Of the five metabolic syndrome indicators, contribution to the risk of experiencing a cardiac event is predominantly additive. Only once a patient acquires four or five of the indicators, does a synergistic relationship begin to become evident in contributing to the odds of experiencing a cardiac event. Hyperuricemia and gout contribute additional risk. Further investigation will examine the interaction between hyperuricemia, gout, and the other components of the metabolic syndrome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-synergistic-effects-of-metabolic-syndrome-indicators-and-hyperuricemia-in-contributing-to-cardiac-event-risk-a-cross-sectional-examination-of-the-nhanes-iii-data/