Early evaluation and management of comorbidities of gout, particularly diabetes mellitus, may reduce future risk for stroke among women with gouty arthritis, according to results of a prospective cohort study published in the European Journal of Clinical Investigation.
Few studies have assessed the link between gout and its comorbidities in a population of female patients. Therefore, the investigators sought to compare the aggregation and transitive trajectories of comorbidities of gout among women and men with the disease. They also studied the correlation between different transition trajectories and the occurrence of stroke. They followed a female and male population of patients with gout from 2000 to 2009 to identify the comorbidities of cardiovascular disease, hypertension, hyperlipidemia, diabetes mellitus, and chronic kidney disease.
The researchers examined the cumulative incidence of stroke from 2000 to 2010. They used a latent trajectory analysis to establish the transitive trajectories of the comorbidities of gout. The study evaluated a total of 2780 patients with gout, 965 of whom were women and 1815 of whom were men. The mean patient age among the women was 64.6±8.1 years vs 63.1±8.5 years among the male population.
Within the 10-year follow-up, both the female and male participants with gout had 5 risk cluster transition (CT) phenotypes: CT1 and CT2, with various persistent comorbidities; CT3, with few persistent comorbidities; and CT4 and CT5, with transfer to cluster 1 from other clusters. The women in CT2 expressed predominantly diabetes mellitus and had a significantly increased risk of developing stroke.
Results of the study demonstrated that the incidence rates of stroke in CT2 (48.4%) and CT4 (58.3%) were high among women compared with the rates in the same 2 clusters among men (22.2% vs 40.7%, respectively). According to logistic regression analysis, among the female participants, CT1 (odds ratio [OR], 5.71; 95% CI, 3.38-9.93), CT2 (OR, 5.32; 95% CI, 2.99-9.47), and CT4 (OR, 7.93; 95% CI, 3.87-16.25) had a significantly increased risk of developing stroke in the 10-year follow-up.
In contrast, among the male participants, CT1 (OR, 6.01; 95% CI, 4.42-8.16), CT4 (OR, 3.78; 95% CI, 2.36-6.05), and CT5 (OR, 3.72; 95% CI, 2.46-5.62) had a significantly increased risk of developing stroke in the 10-year follow-up. An OR of 5.32 in CT2 and 7.93 in CT4 among female participants demonstrated a higher risk for the development of stroke, compared with ORs of 1.57 in CT2 and 3.78 in CT4 among the male participants.
The investigators concluded that the findings from this study can provide additional knowledge and increase clinical awareness with respect to the early assessment and management of gout-related comorbidities among women with gouty arthritis in clinical practice.
Huang H-C, Chiang H-P, Hsu N-W, Huang C-F, Chang SH, Lin K-C. Differential risk group of developing stroke among older women with gouty arthritis: a latent transition analysis [published online March 26, 2019]. Eur J Clin Invest. doi:10.1111/eci.13090