Krishnan E et al. for the MRFIT Research Group (2008) Long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med 168: 1104–1110

Epidemiological studies have inferred an association between gout and cardiovascular events, but the data are inconclusive. Krishnan et al. now report that middle-aged men with gout have a 30% higher risk of coronary heart disease than those without gout.

The study cohort was drawn from 12,866 men (aged 35–57 years) at high cardiovascular risk, but with no overt cardiovascular disease, who enrolled in the Multiple Risk Factor Intervention Trial (MRFIT) in 1973. Participants were randomly assigned to receive usual care or an intervention program that included cholesterol and blood pressure control, and smoking cessation. The Krishnan et al. substudy comprised 9,105 patients who were alive and free from cardiovascular events at the end of the intervention phase in 1982.

At baseline, the sixth annual study visit for each patient, 655 men had gout. These patients were more likely to have high blood pressure, high cholesterol and glucose levels, and to be using diuretics than were participants without gout. After 17 years of follow-up, a total of 2,752 deaths had occurred, 45% of which had a cardiovascular cause. In risk-adjusted analysis, the hazard ratio for death from coronary heart disease in men with gout was 1.35 (95% CI 1.06–1.72, P = 0.01). There were also associations between gout and death from myocardial infarction and between gout and death from any cardiovascular cause, but none reached statistical significance. The results of this study show that gout is a significant, independent risk factor for cardiovascular mortality.