Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction.

Pubmed ID: 22251426

Pubmed Central ID: PMC3392798

Journal: Arthritis research & therapy

Publication Date: Jan. 17, 2012

Affiliation: Department of Medicine, Stanford University School of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, CA 94304, USA. e.krishnan@stanford.edu

MeSH Terms: Humans, Male, Adult, Female, Risk Factors, Middle Aged, Randomized Controlled Trials as Topic, Coronary Disease, Regression Analysis, Multivariate Analysis, Cause of Death, Prognosis, Stroke, Double-Blind Method, Myocardial Infarction, Hyperuricemia, Uric Acid, Coronary Artery Disease, Gout, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Outcome Assessment, Health Care

Authors: Krishnan E, Hariri A, Dabbous O, Pandya BJ, Lingala B

Cite As: Krishnan E, Pandya BJ, Lingala B, Hariri A, Dabbous O. Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction. Arthritis Res Ther 2012 Jan 17;14(1):R10.

Studies:

Abstract

INTRODUCTION: Patients with a history of myocardial infarction (MI) are often at risk for complications, including subsequent MI and death. Use of prognostic markers may aid in preventing these poor outcomes. Hyperuricemia is associated with increased risk for coronary heart disease (CHD) and/or mortality; however, it is unknown if serum urate (sUA) levels predict outcomes in patients with previous MI. The purpose of this study was to assess hyperuricemia as a biomarker of CHD outcomes in such patients. METHODS: These were post hoc analyses of datasets from the Aspirin Myocardial Infarction Study, a 1:1 randomized, double-blind clinical trial, conducted from 1975 to 1979, that examined mortality rates following daily aspirin administration over three years in individuals with documented MI. The primary outcome measures were all-cause death, CHD mortality, coronary incidence, and stroke by quartile of baseline sUA. A sub-analysis of all outcome measures in the presence or absence of gouty arthritis was also performed. RESULTS: Of 4,524 enrolled participants, data on 4,352 were analyzed here. All outcomes were greatest for patients in the fourth sUA quartile. In multivariate regression models, the hazard ratios (HR) for patients in the highest quartile were 1.88 for all-cause mortality (95% confidence interval (CI), 1.45 to 2.46), 1.99 for CHD mortality (95% CI, 1.49 to 2.66), and 1.36 for coronary incidence (95% CI, 1.08 to 1.70). Participants with untreated gout had an adjusted hazard ratio ranging from 1.5 to 2.0 (all P < 0.01) for these outcomes. Participants with gout who were receiving treatment did not exhibit this additional risk. CONCLUSIONS: sUA and untreated gout may be independent prognostic markers for poor all-cause and CHD mortality in patients with recent acute MI.