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The Association Between Gout and Cardiovascular Disease in Patients with Atrial Fibrillation

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Abstract

Gout is a sign of a disturbed metabolism and associated with atrial fibrillation (AF) and other cardiovascular diseases. Our aim was to study associations between gout and cardiovascular comorbidities in patients with AF. The study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF visiting 75 primary care centers in Sweden 2001–2007. Logistic regression was used to calculate odds ratios with 95% confidence intervals (CIs) for the associations between prevalent gout and cardiovascular comorbidities. In subsamples, we studied incident congestive heart failure (CHF) and ischemic stroke (IS), excluding patients with earlier registered specific diagnosis, using Cox regression (to estimate hazard ratios (HR) with 95% CIs). Gout was significantly and positively associated with CHF, obesity and diabetes among men and women, and among men also with hypertension and coronary heart disease. Prevalent gout was negatively associated with incident IS (HR and 95% CI: 0.64, 0.49–0.82; 0.50, 0.39–0.64) in both full model (adjusted for sex, age, socioeconomic factors, and comorbidities) and CHA2DS2-VASc model (adjusted for CHA2DS2-VASc, sex, and age). Adding gout to full model increased Harrell’s C by 1% in CHA2DS2-VASc model. In this clinical setting, we found gout to be associated with most cardiometabolic diseases except cerebrovascular diseases, and with decreased risk of IS, with gout adding significantly to the predictive value compared to CHA2DS2-VASc without gout included.

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Funding

This work was supported by ALF funding awarded to Jan Sundquist and Kristina Sundquist and by grants from the Swedish Research Council (awarded to Kristina Sundquist), the Swedish Council for Working Life and Social Research, Forte (Jan Sundquist), and the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL116381 to Kristina Sundquist.

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Authors and Affiliations

  1. Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden

    Per Wändell & Axel C. Carlsson

  2. Center for Primary Health Care Research, Lund University, Malmö, Sweden

    Jan Sundquist & Kristina Sundquist

  3. Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jan Sundquist & Kristina Sundquist

  4. Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Izumo, Japan

    Jan Sundquist & Kristina Sundquist

Authors
  1. Per Wändell
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  2. Axel C. Carlsson
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  3. Jan Sundquist
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  4. Kristina Sundquist
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Corresponding author

Correspondence to Per Wändell.

Ethics declarations

The investigation conforms with the principles outlined in the Declaration of Helsinki. Ethical approvals were obtained from regional boards at Karolinska Institutet (Dnr 12/2000) and the University of Lund (Dnr 409/2008 with completion from 19/1 2010).

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The authors declare that they have no conflict of interest.

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Significance and relevance:

1. In this clinical setting, we found gout to be associated with most cardiometabolic diseases

2. A diagnosis of gout was associated with a decreased risk of ischemic stroke in patients with atrial fibrillation

3. Identifying a gout diagnosis in patients with atrial fibrillation adds to the predictive value of the risk for ischemic stroke compared to CHA2DS2-VASc without gout included

This article is part of the Topical Collection on Medicine

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Wändell, P., Carlsson, A.C., Sundquist, J. et al. The Association Between Gout and Cardiovascular Disease in Patients with Atrial Fibrillation. SN Compr. Clin. Med. 1, 304–310 (2019). https://doi.org/10.1007/s42399-019-0043-x

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