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Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients

BACKGROUND: Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults. MET...

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Autores principales: Singh, Jasvinder A., Cleveland, John D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984737/
https://www.ncbi.nlm.nih.gov/pubmed/29859125
http://dx.doi.org/10.1186/s13075-018-1606-z
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author Singh, Jasvinder A.
Cleveland, John D.
author_facet Singh, Jasvinder A.
Cleveland, John D.
author_sort Singh, Jasvinder A.
collection PubMed
description BACKGROUND: Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults. METHODS: We assessed the 2006–2012 Medicare 5% claims data for the association of gout at baseline with the occurrence of a new (incident) MI during follow-up (no diagnosis of MI in the baseline period of at least 1 year), adjusting for patient demographics, medical comorbidity (Charlson–Romano index), and commonly used cardiovascular and gout medications, in a Cox proportional hazards model. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS: In a cohort of 1,733,613 eligible people, 14,279 developed incident MI: 13,029 MIs in people without gout and 1250 MIs in those with gout, with crude incident rates of 1.3 vs 4.1 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was significantly associated with a higher hazard of incident MI, with HR of 2.08 (95% CI 1.95, 2.21). Risk was minimally attenuated in sensitivity analyses that replaced the continuous Charlson–Romano index score with a categorical score or individual comorbidities, or expanding to a more sensitive diagnostic algorithm for incident MI, or additionally adjusting for obesity. CONCLUSIONS: Gout was independently associated with a higher risk of MI in the elderly, aged 65 years or older. The role of inflammatory and other pathways need to be explored as underlying mechanisms for this association.
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spelling pubmed-59847372018-06-07 Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients Singh, Jasvinder A. Cleveland, John D. Arthritis Res Ther Research Article BACKGROUND: Current evidence suggests that gout is independently associated with a higher risk of myocardial infarction (MI), but data in older adults at the highest risk of MI are lacking. Our objective was to examine whether gout is associated with a higher risk of incident MI in older adults. METHODS: We assessed the 2006–2012 Medicare 5% claims data for the association of gout at baseline with the occurrence of a new (incident) MI during follow-up (no diagnosis of MI in the baseline period of at least 1 year), adjusting for patient demographics, medical comorbidity (Charlson–Romano index), and commonly used cardiovascular and gout medications, in a Cox proportional hazards model. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. RESULTS: In a cohort of 1,733,613 eligible people, 14,279 developed incident MI: 13,029 MIs in people without gout and 1250 MIs in those with gout, with crude incident rates of 1.3 vs 4.1 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was significantly associated with a higher hazard of incident MI, with HR of 2.08 (95% CI 1.95, 2.21). Risk was minimally attenuated in sensitivity analyses that replaced the continuous Charlson–Romano index score with a categorical score or individual comorbidities, or expanding to a more sensitive diagnostic algorithm for incident MI, or additionally adjusting for obesity. CONCLUSIONS: Gout was independently associated with a higher risk of MI in the elderly, aged 65 years or older. The role of inflammatory and other pathways need to be explored as underlying mechanisms for this association. BioMed Central 2018-06-01 2018 /pmc/articles/PMC5984737/ /pubmed/29859125 http://dx.doi.org/10.1186/s13075-018-1606-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Singh, Jasvinder A.
Cleveland, John D.
Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title_full Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title_fullStr Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title_full_unstemmed Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title_short Gout and the risk of myocardial infarction in older adults: a study of Medicare recipients
title_sort gout and the risk of myocardial infarction in older adults: a study of medicare recipients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984737/
https://www.ncbi.nlm.nih.gov/pubmed/29859125
http://dx.doi.org/10.1186/s13075-018-1606-z
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