Essex Margaret Noyes, Hopps Markay, Bienen E Jay, Udall Margarita, Mardekian Jack, Makinson Geoffrey T
From Pfizer Inc, New York, NY.
J Clin Rheumatol. 2017 Apr;23(3):160-166. doi: 10.1097/RHU.0000000000000496.
The aim of this study was to evaluate relationships between serum uric acid (SUA) and newly emergent acute myocardial infarction (AMI), congestive heart failure (CHF), coronary artery disease (CAD), composite cardiovascular (CV) events (AMI, CHF, CAD), hypertension, hyperlipidemia, and renal disease in gout patients.
Retrospective analysis of electronic medical records from Humedica identified adults (≥18 years) with 2 or more International Classification of Diseases, Ninth Revision, Clinical Modification codes for gout 30 days or more apart (first diagnosis = index event) having 1 or more SUA assessment on or after the index date, and at least 6 months preindex and at least 12 months postindex enrollment. Outcomes were measured during 12 months postindex; patients with preindex events were excluded from analysis of those events. The SUA level (0.01-4.00 mg/dL, 4.01-6.00 mg/dL, 6.01-8.00 mg/dL, and ≥8.01 mg/dL) was determined using the closest laboratory assessment before or on the date of the CV event. Tukey-Kramer comparisons were performed for pairs of SUA strata and Cox proportional model estimated hazard ratios.
A significantly higher incidence of AMI, CHF, and renal disease was observed for patients with 8.01 mg/dL or greater relative to other SUA levels (P < 0.0001), and a significantly higher incidence of composite CV events (AMI, CHF, and CAD) was observed for hypouricemia (SUA, 0.01-4.00 mg/dL) compared with other SUA levels (P < 0.0001). Cox models confirmed the increased risk associated with SUA 8.01 mg/dL or greater; hazard ratios ranged from 1.16 for hypertension to 2.04 for renal disease. Hyperlipidemia and hypertension were diagnosed concurrently with gout in 24% and 28% of patients, respectively.
Hyperuricemia and hypouricemia were associated with an increased risk of CV events.
本研究旨在评估痛风患者血清尿酸（SUA）与新发急性心肌梗死（AMI）、充血性心力衰竭（CHF）、冠状动脉疾病（CAD）、复合心血管（CV）事件（AMI、CHF、CAD）、高血压、高脂血症及肾脏疾病之间的关系。
对来自Humedica的电子病历进行回顾性分析，确定年龄≥18岁的成年人，其国际疾病分类第九版临床修订本中有2个或更多痛风编码，且间隔30天或更长时间（首次诊断为索引事件），在索引日期或之后有1次或更多SUA评估，且在索引日期前至少6个月及索引日期后至少12个月入组。在索引日期后12个月内测量结局；索引日期前有事件的患者被排除在这些事件的分析之外。使用CV事件发生前或当日最近的实验室评估确定SUA水平（0.01 - 4.00mg/dL、4.01 - 6.00mg/dL、6.01 - 8.00mg/dL和≥8.01mg/dL）。对SUA分层进行Tukey-Kramer比较，并使用Cox比例模型估计风险比。
与其他SUA水平相比，SUA水平在8.01mg/dL及以上的患者发生AMI、CHF和肾脏疾病的发生率显著更高（P < 0.0001），与其他SUA水平相比，低尿酸血症（SUA，0.01 - 4.00mg/dL）患者发生复合CV事件（AMI、CHF和CAD）的发生率显著更高（P < 0.0001）。Cox模型证实SUA水平在8.01mg/dL及以上与风险增加相关；风险比范围从高血压的1.16到肾脏疾病的2.04。分别有24%和28%的患者高脂血症和高血压与痛风同时诊断。
高尿酸血症和低尿酸血症均与CV事件风险增加相关。
