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Gout/Uric acid may boost cardiovascular mortality
By Jill Stein
BARCELONA (Reuters Health) - Men with gout are significantly more likely to die of an acute myocardial infarction (MI) than men without gout, researchers reported here at the European League Against Rheumatism (EULAR) 2007.
What's more, the increased risk cannot be explained by conventional cardiovascular risk factor status.
"We found that the presence of gout increased cardiovascular mortality about 16 years later," Dr. Eswar Krishnan, assistant professor of medicine at the University of Pittsburgh, pointed out.
His group conducted a 16-year follow-up analysis of 9,105 men between 41 and 63 years old who had no clinical or ECG evidence of coronary artery disease or any cardiovascular event at the end of the Multiple Risk Factor Intervention Trial (MRFIT) trial. The MRFIT trial was a National Institutes of Health-funded coronary heart disease prevention trial.
While there have been reports of an increased short-term risk of coronary artery disease in gout patients, there are limited data on the long-term cardiovascular mortality, Dr. Krishnan said.
In this study, the threshold for defining high uric acid was 7 mg/dL or greater, and patients with self-reported gout needed to have high uric acid to be counted as gout cases.
After controlling for known risk factors such as high blood pressure, cholesterol, smoking, obesity, alcohol use, family history of MI, use of diuretics and aspirin, and impaired kidney function, men with gout were about 50% more likely to die of acute MI than men without gout.
Dr. Krishnan said that the findings may suggest that uric acid is a marker for oxidative stress. "In other words, uric acid may not be harmful itself but rather the 'smoke around the fire.'"
He added that the data unequivocally mean that physicians should aggressively screen their gout patients for cardiovascular risk factors.
"Our approach to patients with gout should be similar to our approach to diabetics," he said. "We take extra care to check out diabetic patients for cardiovascular risk. We make sure their eyes are OK and that their cholesterol is OK and that they exercise. The message from our study is that gout should be treated on a par with diabetes."
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