Kim Seoyoung C, Liu Jun, Solomon Daniel H
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ann Rheum Dis. 2016 Aug;75(8):1473-8. doi: 10.1136/annrheumdis-2015-208161. Epub 2015 Aug 31.
Atrial fibrillation (AF) is the most common arrhythmia associated with cardiovascular disease and mortality. Recent studies suggest an association between inflammation, hyperuricaemia and AF, but little is known whether gout is associated with AF risk.
Using data from a US commercial insurance plan (2004-2013), we conducted a cohort study to evaluate the risk of incident AF in patients with gout versus osteoarthritis. Patients with gout or osteoarthritis were identified with ≥2 diagnoses and ≥1 dispensing for gout or osteoarthritis medications. Incident AF was defined as a new AF diagnosis and a new dispensing for anticoagulants or antiarrhythmics. The risk of incident AF in gout was also compared with the non-gout group.
We identified 70 015 patients with gout and 210 045 with osteoarthritis, matched on age, sex and index date. The mean age was 57 years, and 81% were men. Over the mean 2-year follow-up, the incidence rate of AF per 1000 person-years was 7.19 in gout and 5.87 in osteoarthritis. The age, sex and index date-matched HR of AF was 1.23 (95% CI 1.14 to 1.32) in gout versus osteoarthritis. In a multivariable Cox regression, adjusting for age, sex, comorbidities, medications and healthcare usage, the HR of AF in gout was 1.13 (95% CI 1.04 to 1.23). When compared with non-gout, the multivariable HR of AF in gout was also increased (HR 1.21, 95% CI 1.11 to 1.33).
In this large population-based cohort study, gout was associated with a modestly increased risk of incident AF compared with osteoarthritis and non-gout after adjusting for other risk factors.
心房颤动（AF）是与心血管疾病和死亡率相关的最常见心律失常。近期研究提示炎症、高尿酸血症与AF之间存在关联，但痛风是否与AF风险相关却知之甚少。
利用美国一项商业保险计划（2004 - 2013年）的数据，我们开展了一项队列研究，以评估痛风患者与骨关节炎患者发生AF的风险。痛风或骨关节炎患者通过≥2次诊断及≥1次痛风或骨关节炎药物配药来确定。新发AF定义为新的AF诊断以及新的抗凝剂或抗心律失常药物配药。还比较了痛风患者与非痛风组发生AF的风险。
我们确定了70015例痛风患者和210045例骨关节炎患者，根据年龄、性别和索引日期进行匹配。平均年龄为57岁，81%为男性。在平均2年的随访期间，痛风患者每1000人年的AF发病率为7.19，骨关节炎患者为5.87。痛风组与骨关节炎组经年龄、性别和索引日期匹配后的AF风险比（HR）为1.23（95%可信区间[CI] 1.14至1.32）。在多变量Cox回归分析中，校正年龄、性别、合并症、药物和医疗保健使用情况后，痛风患者AF的HR为1.13（95%CI 1.04至1.23）。与非痛风组相比，痛风患者AF的多变量HR也升高（HR 1.21，95%CI 1.11至1.33）。
在这项基于人群的大型队列研究中，校正其他风险因素后，与骨关节炎和非痛风相比，痛风与新发AF风险适度增加相关。
