Older Gout Patients May Be At An Increased Risk for Heart Failure

Older adults with gout may be at risk for heart failure (HF), according to a study.

Previous research has identified an increased risk for coronary heart disease (CHD) and stroke in this patient population, but fewer have assessed HF risk, the study authors observed.

“Many risk factors for CHD and stroke, including hypertension, diabetes, cigarette smoking, and obesity, are also associated with an increased risk for heart failure (HF),” they wrote. “If gout is associated with an increased risk for HF, this would support the need for interventions to prevent its occurrence in this population.”

Data were collected on 5,713 adults aged 65.5 years or older in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. Patients were eligible for inclusion if they had Medicare coverage and no prior history of HF, CHD, or stroke at baseline. Gout was defined as at least one hospitalization or at least two outpatient visits with a diagnosis code for gout in Medicare claims before the patient’s baseline exam. Patients from the REGARDS study were followed for HF hospitalization, CHD, stroke, and all-cause mortality. The researchers replicated analyses in a random sample of 839,059 patients aged 65.5 years or older with Medicare coverage.

Gout Increases HF Risk

Mean age at baseline among the REGARDS group was 72.6 years; 44.9% were male, 31.4% were black, and 3.3% had gout. Median follow-up was 10 years, during which time incidence rates per 1,000 person-years among patients with and without gout were 13.1 and 4.4 for HF hospitalization, 16.0 and 9.3 for CHD, 9.3 and 8.2 for stroke, and 55.0 and 37.1 for all-cause mortality, respectively. When adjusting for sociodemographic variable and cardiovascular risk factors, the hazard ratio (HR) for patients with versus without gout for HF hospitalization was 1.97 (95% confidence interval [CI], 1.22 to 3.19). The HR for CHD was 1.21 (95% CI, 0.79 to 1.84), for stroke was 0.83 (95% CI, 0.48 to 1.43), and for all-cause mortality was 1.08 (95% CI, 0.86 to 1.35). Upon multivariable-adjusted analysis, the HR for HF hospitalization with reduced and preserved left ventricular ejection fraction in patients with versus without gout was 1.77 (95% CI, 0.83 to 3.79) and 2.32 (95% CI, 1.12 to 4.79), respectively. In the cohort of Medicare beneficiaries, the multivariable-adjusted HR for HF hospitalization associated with gout was 1.32 (95% CI, 1.25 to 1.39).

The study was published in Arthritis Research & Therapy.

The researchers concluded that older patients with gout are at risk for incident HF, which was consistent across sex- and race-related analyses.

“Interventions to reduce the excess risk for incident HF among older adults with gout are warranted,” they recommended.