Background/Purpose: Diabetes is a well-recognized risk factor for heart disease, increasing the risk of heart disease by 2-3 fold in many studies. Recent ACC/AHA lipid guidelines have a different pathway for diabetes patients. Gout has been shown to be a risk factor for myocardial infarction and stroke in some cohort studies.  It is not known whether gout is as strong a risk factor for acute myocardial infarction as diabetes, a question we attempted to answer with the current study. We compared the incidence of hospitalized acute myocardial infarction (MI) between patients with DM and or RA.

Methods: We used claims data from 2006 to 2010 that included a mix of private and public health plans with medical and pharmacy coverage.  Four mutually exclusive cohorts were identified: 1) Gout and DM; 2) Gout only; 3) DM only; and 4) neither gout nor diabetes.  Patients with prior CHD during a baseline period of ³ 1 year were excluded using relevant diagnosis codes. Outcomes were defined as at least one overnight stay, unless the patient died, plus the presence of ³ 1 inpatient hospital claim with a discharge ICD-9 code 410.x1 in any position for Acute MI or presence of ICD-9 code for stroke (430.XX, 431.xx, 433.x1(433.01, 433.11, 433.21, 433.31, 433.81, 433.91), 434 (434.01, 434.11, 434.91 ,excluding 434.x0), 436.XX) in any position. We compared the age- and gender-specific incidence of acute MI and stroke rates across the four cohorts.  We assessed univariate and multivariable-adjusted hazard rates of acute MI and stroke.

Results:   A total of 298,929 patients had diabetes, 91999 had gout, 37573 had both and 1,099,373 had neither. Compared to patients with neither, those with gout or DM or both were older.  Incidence of acute MI was lowest in patients with neither, followed by patients with gout, diabetes and both –e.g. in men, respective rates/1000 person-years were 0.0138, 0.0271, 0.0291 and 0.0475. Similar trend were noted for stroke. In unadjusted analyses, both gout and DM increased the risk of acute MI and stroke by a similar magnitude (Table 1). In multivariable-adjusted analyses, gout was associated with significantly lower risk of acute MI than diabetes, but no significant differences were noted between gout and DM for the risk of stroke (Table 1).  Patients with both gout and DM had 1.26 and 1.29-times higher hazard of acute MI and stroke, compared to patients with diabetes only (Table 1).  

Conclusion: Gout increases the risk of incident MI significantly but does not appear to be a CHD risk equivalent comparable to DM for incident MI. Gout is a CHD risk equivalent comparable to DM for stroke. Having both gout and DM confers incremental risk compared to DM alone for both MI and stroke.

Table 1. Unadjusted and multivariable-adjusted hazards of MI and stroke with gout and diabetes