Increased Risk for Noncardiovascular Deaths in Patients With Gout

Gout was associated with an increased risk for noncardiovascular-related deaths in a cohort of Swedish individuals, according to data published in Arthritis & Rheumatology.

The investigators conducted a cohort study of all adult (18+ years) residents of Skåne, Sweden, between 1998 and 2002, identified via the Swedish Population Register. Residents who received a new diagnosis of gout between 2003 and 2013 were identified with the Skåne Healthcare Register. Patients with gout were age- and sex-matched with 10 random healthy control individuals. Residents were assessed until death, their relocation outside of Skåne, or the conclusion of follow-up in 2014. The underlying cause of death was abstracted from the Causes of Death Register; hazard ratios (HRs) of mortality were then estimated for specific causes among patients with gout.

From a source population of 832,258 residents, 19,497 (32% women) received a new diagnosis of gout between 2002 and 2013. Patients were matched with 194,947 comparators; both the patients and control groups had a mean age of 70 years (68% men). Compared with control individuals, patients with gout had higher prevalence of chronic kidney disease, metabolic comorbidities, and cardiovascular comorbidities. Gout was associated with a 17% increased hazard for all-cause mortality (HR, 1.17; 95% CI, 1.14-1.21). The hazard for mortality related to gout was greater among women (HR, 1.23; 95% CI, 1.17-1.30) compared with men (HR, 1.15; 95% CI, 1.10-1.19). Cardiovascular diseases were the main cause of death for both patients and control individuals, contributing to 49.5% and 41.3% of deaths for each group, respectively. An increased hazard of death from cardiovascular causes was confirmed in patients with gout (HR, 1.27; 95% CI, 1.22-1.33). Patients with gout also experienced an increased hazard for death because of renal disease (HR, 1.78; 95% CI, 1.34-2.35), diseases of the digestive system (HR, 1.56; 95% CI, 1.34-1.83), and infections (HR, 1.20; 95% CI, 1.06-1.35). A negative association was observed between gout and hazard for mortality resulting from dementia (HR, 0.83; 95% CI, 0.72-0.97).

Although prior research has indicated that gout increases risk for death because of cardiovascular complications, these data highlight elevated mortality from noncardiovascular causes. Better management of noncardiovascular comorbidities may improve long-term outcomes among patients with gout. Further research into the relationship between gout and renal disease is necessary to curb the high risk for death from renal disease observed among this patient group.

Disclosures

One author’s work was funded by the National Institutes of Health, and the authors thank Professor Martin Englund from Lund University for access to the register data.

Reference

Vargas-Santos AB, Neogi T, da Rocha Castelar-Pinheiro G, Kapetanovic MC, Turkiewicz A. Cause-specific mortality in gout: novel findings of elevated risk of non-cardiovascular related deaths [published online June 6, 2019]. Arthritis Rheumatol. doi:10.1002/art.41008