Kubota Yasuhiko, McAdams-DeMarco Mara, Folsom Aaron R
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Departments of Epidemiology and Surgery, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
Thromb Res. 2016 Aug;144:144-8. doi: 10.1016/j.thromres.2016.06.020. Epub 2016 Jun 17.
Inflammatory diseases increase risk of venous thromboembolism (VTE). Whether gout, the most common rheumatologic inflammatory arthritis, or its cause, elevated serum uric acid (SUA), is associated with VTE incidence is unknown.
The Atherosclerosis Risk in Communities Study measured SUA in 14126 participants aged 45-64, without a history of VTE or gout and not using anticoagulants/gout medications, and obtained information on incident gout between 1987 and 1998 from 10247. We followed them for VTE occurrence from 1987 to 2011. Hazard ratios (HRs) of VTE were estimated using Cox proportional hazards models.
We documented 632 incident cases of VTE (236 unprovoked and 396 provoked). Age, sex, and race-adjusted HRs for total VTE were 1, 1.40, 1.43, 1.91, 1.71, and 3.25 (P for trend<0.001) across levels of SUA (range mg/dL: ≤4.9, 5.0-5.9, 6.0-6.9, 7.0-7.5, 7.6-8.7, and ≥8.8). After adjustment for other VTE risk factors, those in the highest level of SUA had HRs [95% confidence interval] of 2.13 (1.47-3.07) for total VTE, 2.07 (1.17-3.67) for unprovoked VTE and 2.16 (1.33-3.50) for provoked VTE. Those with incident gout had a nonsignificantly increased risk of total VTE [HR (95% CI): 1.33 (0.95-1.86)].
Elevated SUA was associated with an increased risk of VTE, suggesting that SUA might be a novel risk factor or marker for VTE. Further studies are needed to assess the association between gout and VTE.
炎症性疾病会增加静脉血栓栓塞（VTE）的风险。痛风作为最常见的风湿性炎症性关节炎，或者其病因血清尿酸（SUA）升高，是否与VTE发病率相关尚不清楚。
社区动脉粥样硬化风险研究对14126名年龄在45 - 64岁、无VTE或痛风病史且未使用抗凝剂/痛风药物的参与者测量了SUA，并从10247名参与者中获取了1987年至1998年间痛风发病的信息。我们对他们从1987年至2011年进行VTE发生情况的随访。使用Cox比例风险模型估计VTE的风险比（HRs）。
我们记录了632例VTE事件（236例无诱因和396例有诱因）。在不同SUA水平（范围mg/dL：≤4.9、5.0 - 5.9、6.0 - 6.9、7.0 - 7.5、7.6 - 8.7和≥8.8）中，经年龄、性别和种族调整后的总VTE的HR分别为1、1.40、1.43、1.91、1.71和3.25（趋势P<0.001）。在调整其他VTE风险因素后，SUA水平最高的人群中，总VTE的HR[95%置信区间]为2.13（1.47 - 3.07），无诱因VTE为2.07（1.17 - 3.67），有诱因VTE为2.16（1.33 - 3.50）。痛风发病者总VTE风险增加但无统计学意义[HR（95%CI）：1.33（0.95 - 1.86）]。
SUA升高与VTE风险增加相关，提示SUA可能是VTE的一个新的风险因素或标志物。需要进一步研究以评估痛风与VTE之间的关联。
