Burke Bridget Teevan, Köttgen Anna, Law Andrew, Grams Morgan, Baer Alan N, Coresh Josef, McAdams-DeMarco Mara A
Department of Epidemiology, JHU Bloomberg School of Public Health, Baltimore, Maryland.
Department of Epidemiology, JHU Bloomberg School of Public Health, Baltimore, Maryland. Division of Nephrology, University Medical Center Freiburg, Germany.
J Gerontol A Biol Sci Med Sci. 2016 Apr;71(4):536-42. doi: 10.1093/gerona/glv120. Epub 2015 Dec 28.
It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age.
We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population-based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model.
The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63-6.63) increased gout risk in older age.
These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age.
中年时期的传统风险因素和遗传风险因素是否能预测老年时期痛风的发病尚不清楚。
我们利用社区动脉粥样硬化风险研究对老年人痛风发病率进行了研究，该研究是一项基于美国人群的前瞻性队列研究，纳入了1987年至1989年间登记的中年成年人，并进行持续随访。根据八个基因的常见尿酸相关单核苷酸多态性构建了遗传尿酸评分。使用Cox比例风险模型估计中年时期传统和遗传风险因素导致痛风发病的校正风险比和95%置信区间。
中年至65岁男性的累积发病率为8.6%，女性为2.5%；到75岁时，累积发病率分别为11.8%和5.0%。在中年时期，肥胖增加、啤酒摄入量、蛋白质摄入量、吸烟状况、高血压、利尿剂使用和肾功能（但不包括性别）与老年痛风风险增加相关。此外，遗传尿酸评分每增加100 µmol/L，老年痛风风险增加3.29倍（95%置信区间：1.63 - 6.63）。
这些发现表明，中年时期的传统和遗传风险因素可能有助于识别老年时期有痛风风险的人群。
