McAdams-DeMarco Mara A, Maynard Janet W, Coresh Josef, Baer Alan N
Arthritis Res Ther. 2012 Aug 20;14(4):R193. doi: 10.1186/ar4026.
There is a growing prevalence of gout in the US and worldwide. Gout is a recognized risk factor for cardiovascular disease (CVD). It is unclear whether other risk factors for CVD are also associated with increased risk of gout. Anemia is one such CVD risk factor. No studies have evaluated the relationship between anemia and gout. We tested whether anemia was associated with incident gout independent of comorbid conditions in Atherosclerosis Risk in the Communities.
This population-based cohort recruited 15,792 individuals in 1987 to 1989 from four US communities and contained nine years of follow-up. Anemia was defined as hemoglobin <13.5 g/dL for men and <12 g/dL for women. Using a Cox Proportional Hazards model, we estimated the hazard ratio (HR) and confidence intervals (CI) of incident gout by baseline anemia, adjusted for confounders (sex, race, estimated glomerular filtration rate, body mass index and alcohol intake) and clinical factors (coronary heart disease, congestive heart failure, diabetes, hypertension, diuretic use and serum urate level).
Among the 10,791 participants, 10% had anemia at baseline. There were 271 cases of incident gout. Patients with anemia had a two-fold increased risk of developing gout over nine years (HR = 2.01, 95% CI: 1.46, 2.76). Anemia was associated with incident gout independent of known gout risk factors, confounders and clinical risk factors (HR = 1.73, 95% CI: 1.24, 2.41). This association persisted after additionally adjusting for serum urate level (HR = 1.83, 95% CI: 1.30, 2.57).
We identified anemia as a novel risk factor for gout. Anemia was associated with an approximately two-fold increased risk of gout-independent kidney function and serum urate. These findings suggest that anemia is a risk factor for gout on par with other chronic conditions such as obesity and diabetes. The biological mechanism linking anemia to gout remains unclear.
在美国及全球范围内，痛风的患病率正不断上升。痛风是公认的心血管疾病（CVD）风险因素。目前尚不清楚其他心血管疾病风险因素是否也与痛风风险增加相关。贫血就是这样一种心血管疾病风险因素。此前尚无研究评估贫血与痛风之间的关系。我们在社区动脉粥样硬化风险研究中，检验了贫血是否独立于合并症与痛风发病相关。
该基于人群的队列研究于1987年至1989年从美国四个社区招募了15,792名个体，并进行了九年的随访。贫血定义为男性血红蛋白<13.5 g/dL，女性血红蛋白<12 g/dL。使用Cox比例风险模型，我们通过基线贫血情况估计痛风发病的风险比（HR）和置信区间（CI），并对混杂因素（性别、种族、估计肾小球滤过率、体重指数和酒精摄入量）和临床因素（冠心病、充血性心力衰竭、糖尿病、高血压、利尿剂使用和血清尿酸水平）进行了调整。
在10,791名参与者中，10%在基线时患有贫血。共有271例痛风发病病例。贫血患者在九年内患痛风的风险增加了两倍（HR = 2.01，95% CI：1.46，2.76）。贫血与痛风发病相关，且独立于已知的痛风风险因素以及混杂因素和临床风险因素（HR = 1.73，95% CI：1.24，2.41）。在进一步调整血清尿酸水平后，这种关联仍然存在（HR = 1.83，95% CI：1.30，2.57）。
我们确定贫血是痛风的一个新风险因素。贫血与痛风发病风险增加约两倍相关，且独立于肾功能和血清尿酸。这些发现表明，贫血与肥胖和糖尿病等其他慢性疾病一样，是痛风的一个风险因素。贫血与痛风之间的生物学机制仍不清楚。
