Association Between Gout and Aortic Stenosis - 18/04/17

Doi : 10.1016/j.amjmed.2016.09.005

Kevin Chang, MD ^a,^b,^c,^{^{1
These authors contributed equally to this manuscript.}}, Chio Yokose, MD ^a,^b,^c,^{^{1
These authors contributed equally to this manuscript.}}, Craig Tenner, MD ^c,^d,^e, Cheongeun Oh, PhD ^c,^f, Robert Donnino, MD ^c,^g,^h,ⁱ, Alana Choy-Shan, MD ^c,^g,^h, Virginia C. Pike, BA ^a,^b,^c, Binita D. Shah, MD, MS ^c,^g,^h, Jeffrey D. Lorin, MD ^c,^g,^h, Svetlana Krasnokutsky, MD, MS ^a,^b,^c,^{^{1
These authors contributed equally to this manuscript.}}, Steven P. Sedlis, MD ^c,^g,^h,^{^{1
These authors contributed equally to this manuscript.}}, Michael H. Pillinger, MD ^a,^b,^c,^⁎,^{^{1
These authors contributed equally to this manuscript.}}
^a Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System
^b Division of Rheumatology, Department of Medicine, New York University School of Medicine
^c TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
^d Section of Primary Care, Department of Medicine, Veterans Affairs New York Harbor Healthcare System
^e Division of Primary Care, Department of Medicine, New York University School of Medicine
^f Department of Biostatistics, New York University
^g Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System
^h Division of Cardiology, Department of Medicine, New York University School of Medicine
ⁱ Department of Radiology, New York University School of Medicine

^∗Requests for reprints should be addressed to Michael H. Pillinger, MD, Section of Rheumatology, Department of Medicine, VA New York Harbor Healthcare System, New York Campus, United States Department of Veterans Affairs, 423 E. 23rd Street, New York, NY 10010.Section of RheumatologyDepartment of MedicineVA New York Harbor Healthcare SystemNew York CampusUnited States Department of Veterans Affairs423 E. 23rd StreetNew YorkNY10010

Abstract

Background

An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis.

Methods

We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis.

Results

Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16).

Conclusions

Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications.

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Keywords : Aortic stenosis, Gout, Valvular heart disease

Plan

Increased Prevalence of Gout in Patients with Aortic Stenosis

Comparison of Aortic Stenosis Patients with and without Gout

Discussion

Conclusion

	Funding: No outside support was received for the conduct of this research or the preparation of this manuscript.
	Conflict of Interest: MHP and BDS receive support from NYU CTSA grant 1UL1TR001445 from the National Center for the Advancement of Translational Science (NCATS), NIH. BDS was supported in part by the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development (I01BX007080). SK was supported in part by an Investigator Award from the Rheumatology Research Foundation. BDS and SK were supported in part by a New York State Empire Clinical Research Investigator Program (ECRIP) award. MHP serves or has served as a consultant for AstraZeneca, Crealta/Horizon, and Sobi, and has been an investigative site for a sponsored trial by Takeda. SK has served as a consultant for Crealta/Horizon. BDS receives research grant support from Siemens. MHP, BDS, and SPS have previously received research grant support from Takeda. KC, CY, CT, AC-S, and RD report no disclosures.
	Authorship: All authors had access to the data and a role in writing this manuscript.

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Vol 130 - N° 2

P. 230.e1-230.e8 - février 2017 Retour au numéro

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Association Between Gout and Aortic Stenosis - 18/04/17

Abstract

Background

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