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Association of gout with major adverse cardiovascular events and all-cause mortality in patients with peripheral artery disease

  • Tejas P. Singh
    Affiliations
    Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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  • Shannon Wong
    Affiliations
    Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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  • Frank Quigley
    Affiliations
    The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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  • Jason Jenkins
    Affiliations
    Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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  • Jonathan Golledge
    Correspondence
    Corresponding author. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia, 4811.
    Affiliations
    Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

    The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia

    The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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      Highlights

      • Gout is associated with an increased risk of major cardiovascular events (MACE) but whether this is independent of traditional cardiovascular risk factors is unclear.
      • MACE and all-cause mortality were more common in patients with peripheral artery disease (PAD) with a history of gout.
      • This association was not independent of traditional cardiovascular risk factors.

      Abstract

      Background and aims

      Prior epidemiological studies have suggested that individuals with gout are at greater risk of cardiovascular events, but there have been no studies in people with peripheral artery disease (PAD). The aim of this study was to investigate the relationship between gout and major adverse cardiovascular events (MACE) and all-cause mortality in people with PAD.

      Methods

      Participants with a range of PAD presentations, including carotid artery disease, aortic or peripheral aneurysm and lower limb PAD, were prospectively recruited from outpatient vascular departments within Australia. MACE (myocardial infarction, stroke or cardiovascular death) and all-cause mortality were identified through out-patient follow-up and linked medical records. Propensity-score matching was undertaken to generate a matched cohort of patients with and without a history of gout. Kaplan-Meier survival analysis and Cox-proportional hazard analysis were used to examine the association of gout with MACE and all-cause mortality.

      Results

      A total of 4308 people with PAD, of whom 334 had a history of gout, were included and followed for a median (inter-quartile range) of 2.1 (0.1–5.9) years. In the unadjusted analyses, participants with gout were at increased risk of MACE (hazard ratio, HR 1.37, 95% confidence intervals, CI 1.09–1.71, p = 0.006) and all-cause mortality (HR 1.38, 95% 1.13–1.68, p = 0.002), however, the associations were lost in the adjusted analyses. In the propensity-score matched cohort, gout was not significantly associated with an increased risk for MACE or all-cause mortality.

      Conclusions

      Gout was not independently associated with increased cardiovascular events in PAD patients.

      Graphical abstract

      Keywords

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