Background/Purpose: The disease burden of female gout has increased in recent years.¹ However, there remains a paucity of data on female gout, despite it being more frequently associated with key cardiovascular risk factors compared with male gout.^2,3 Among men, gout is independently associated with increased risk of mortality and coronary heart disease (CHD) in prospective cohort studies where relevant lifestyle and other risk factors were accounted for; ⁴ no equivalent quantitative data are available among women. Thus, we sought to prospectively examine the impact of gout on risk of all-cause and cardiovascular deaths among women.

Methods: The Nurses’ Health Study (NHS) is an ongoing longitudinal cohort study in which female nurses in the United States completed detailed mailed questionnaires at baseline and every two years thereafter. We prospectively examined the association between gout and CHD status at baseline and during the follow-up period and the risk of all-cause, cardiovascular disease (CVD), and CHD mortality using Cox proportional hazards regression models adjusting for covariates such as age, menopausal status, hormone replacement therapy use, history of hypertension, hypercholesterolemia, or diabetes, aspirin or diuretic use, tobacco use, body mass index (BMI), and physical activity. Response rates to questionnaires have exceeded 90% of eligible person-time in the NHS. Cause of death was determined using death certificates, medical records, and autopsy results, and classified using International Classification of Diseases codes.

Results: The analysis included 116,352 women without gout and 2,058 women with gout at baseline. Women with gout tended to have higher mean age and BMI, as well as higher prevalence of hypertension, hypercholesterolemia, and diabetes compared to those without gout across both strata of baseline CHD status (Table 1). During 34 years of follow-up, we documented 49,716 deaths from all causes, including 11,376 deaths from cardiovascular disease (CVD) and 4,243 from CHD. Compared to women without CHD or gout at baseline, the multivariate relative risk (RRs) of all-cause deaths were 1.28 (95% CI, 1.21 to 1.63), 1.29 (1.24 to 1.35), and 1.52 (1.30 to 1.78) among those without CHD/with gout, with CHD/without gout, and with CHD/with gout at baseline, respectively (Figure 1). The corresponding RRs based on gout status at baseline and updated during follow-up were 1.21 (1.16 to 1.27), 1.38 (1.35 to 1.41), and 1.62 (1.53 to 1.71), respectively. Compared to women without CHD or gout at baseline, the RRs of all CVD deaths were 1.33 (1.19 to 1.48), 1.87 (1.76 to 2.02), and 2.08 (1.63 to 2.65) among those without CHD/with gout, with CHD/without gout, and with CHD/with gout at baseline, respectively (Figure 1).

Conclusion: These prospective data indicate that women with gout have a higher risk of all-cause mortality, which is primarily driven by higher risk of CVD deaths. These results support that more intensive cardiovascular risk factor modification specifically focused on women with gout is indicated to curtail the rising morbidity and mortality associated with gout worldwide.

References:
1. Xia et al., PMID 31624843
2. Puig et al., PMID 2012455
3. Harrold et al., PMID 16644784
4. Choi et al., PMID 17698728

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-independent-impact-of-gout-on-mortality-and-risk-of-coronary-heart-disease-among-women-a-prospective-cohort-analysis-of-women-over-34-years/