Background/Purpose: Hyperuricemia i.e. increased s-uric acid levels (s-UA), is established risk factor for clinical gout. Studies regarding the absolute and relative effect on population level have suggested a dose-dependent increase in risk of developing gout with increasing serum urate level (1). We aimed to explore the long-term risk of developing gout among asymptomatic adults with different levels of baseline hyperuricemia who participated in Malmö Preventive Project (MPP).

Methods: MPP is a screening program for cardiovascular risk factors, alcohol abuse and breast cancer in Malmö, Sweden. Overall, 33.346 individuals (67% male, mean age 45.7 years at inclusion, mean follow up 28.2 years) participated. The study population was screened between 1974 and 1992. A baseline health screening included: questionnaire with 260 questions (socioeconomic factors, alcohol consumption, smoking, physical activity, dietary habits, history of gout and other co-morbidities); physical examination (length, weight, blood pressure), and laboratory tests (s-UA, fasting glucose, s-creatinine). Endpoint was defined as date of first gout diagnosis, death, moving from area or December 31^st 2014.

In order to identify all gout diagnoses (using ICD-codes) given at visits to physicians within primary care, specialized in-patient and out-patient specialized care, MPP cohort was linked to regional health care register and to national patient register, respectively. Baseline s-UA levels were stratified into 4 categories: normal levels (≤ 360 µmol /L; 361-405 (levels under tissue solubility of UA); 406-500 and >500. The absolute risks for gout by these s-UA strata are presented and Cox regression models are used to determine the relative risks; unadjusted and age-adjusted.

Results: Overall, 1279 individuals (3.8%), 1018 men (4.5%) and 261 women (2.4%) of these middle-aged subjects developed gout during the follow up. Of those with s-UA 406-500 and >500 µmol/L corresponding absolute risks were 14% and 21.7% (men) and 15.6% and 52.9 (women). Compared to subjects with low s-UA levels, subject with different levels of hyperuricemia had an increase HR for being diagnosed with gout, with HRs varying in men between 3 -15 and in women between 6 -106 (Table).

Conclusion: The risk for developing gout over 30 years in middle-aged subjects was 3.8% but varied considerably with baseline s-UA levels. Compared to normal S-UA levels, having s-UA>500 µmol/L was associated with 15- and 100-fold increased risk of gout in men and women, respectively. These results indicate the risk for developing gout in hyperuricemic subjects may be higher than previously reported.

(1) Duskin-Bitan H at al. The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort. Clin Rheumatol (2014) 33:549–553

Table. Risk of developing clinically gout over 30 years in man and women by different levels of baseline s-UA

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-absolute-risk-of-clinically-diagnosed-gout-by-serum-uric-acid-levels-results-from-30-years-follow-up-of-the-malmo-preventive-project-cohort-in-southern-sweden/