THE IMPACT OF CHANGES IN CARDIOVASCULAR RISK PROFILES OVER 10 YEARS BETWEEN PATIENTS WITH GOUT AND THE GENERAL POPULATION ON MAJOR ADVERSE CARDIOVASCULAR EVENTS: A NATIONWIDE COHORT STUDY

초록

Background: During the progression from asymptomatic hyperuricemia to gout, cardiovascular risk profiles associated with gout may also change. Consequently, these long-term changes and interactions may affect the risk of incident cardiovascular events. Therefore, the impact of gout and long-term changes in cardiovascular risk profile on cardiovascular events is unclear. Objectives: To determine whether gout increases the risk of incident cardiovascular events, and long-term changes in cardiovascular risk profile affect the risk of cardiovascular events in patients with gout. Methods: This was a nationwide cohort study based on the Korean National Health Insurance claims database and data from the National Health Screening Program. Individuals aged 20 to 90 years who were newly diagnosed with gout between January 2012 and August 2019 and age- and sex-matched control individuals without gout were included. Cardiovascular risk profiles, their long-term changes, incidence rates of cardiovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage), and all-cause death were assessed. After adjusting for cardiovascular risk profiles that existed 10 years before the diagnosis of gout and their subsequent changes, the relative risks of incident cardiovascular events and all-cause death in the gout patients were assessed. Results: In total, 113,853 patients with gout and 1,138,530 matched controls were studied. Compared with matched controls, gout patients had worse cardiovascular risk profiles 10 years before the diagnosis, but not statistically significant. Gout patients were followed for median 2.6 years (up to 6.9 years) after gout diagnosis. Multivariable analysis showed that gout was associated with increased risks for myocardial infarction (adjusted hazard ratio [HR]: 1.39, 95% confidence interval (CI): 1.27–1.52, P<0.001), cerebral infarction (adjusted HR: 1.36, 95% CI: 1.26–1.46, P<0.001), cerebral hemorrhage (adjusted HR: 1.50, 95% CI: 1.33–1.71, P<0.001), and all-cause death (adjusted HR: 1.07, 95% CI: 1.02–1.12, P=0.004). In addition, p for interactions was significant for myocardial infarction (Grade 1 aggravation of diastolic blood pressure, P=0.042), cerebral infarction (Grade 2 aggravation of diastolic blood pressure P=0.037), and cerebral hemorrhage (Grade 2 aggravation over 10 years of total cholesterol P=0.057). Conclusion: Gout patients had a high risk of incident cardiovascular events even after adjusting for cardiovascular risk profiles and their long-term changes. These long-term changes additively increases the risk of CV event in gout patients.