痛风与老年人新发心力衰竭风险增加相关：地理和种族差异导致中风的原因（REGARDS）队列研究。
Gout is associated with an increased risk for incident heart failure among older adults: the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study.
机构信息
Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL, 35294-0013, USA.
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Arthritis Res Ther. 2020 Apr 16;22(1):86. doi: 10.1186/s13075-020-02175-2.
BACKGROUND
Gout has been associated with a higher risk for coronary heart disease (CHD) and stroke in some prior studies. Few studies have assessed the association of gout with incident heart failure (HF).
METHODS
We analyzed data from 5713 black and white men and women ≥ 65.5 years of age in the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who had Medicare coverage without a history of HF, CHD, or stroke at baseline between 2003 and 2007. Gout was defined by ≥ 1 hospitalization or ≥ 2 outpatient visits with a diagnosis code for gout in Medicare claims prior to each participant's baseline study examination. REGARDS study participants were followed for HF hospitalization, CHD, stroke, and all-cause mortality as separate outcomes through December 31, 2016. Analyses were replicated in a random sample of 839,059 patients ≥ 65.5 years of age with Medicare coverage between January 1, 2008, and June 30, 2015, who were followed through December 31, 2017.
RESULTS
Among REGARDS study participants included in the current analysis, the mean age at baseline was 72.6 years, 44.9% were men, 31.4% were black, and 3.3% had gout. Over a median follow-up of 10.0 years, incidence rates per 1000 person-years among participants with and without gout were 13.1 and 4.4 for HF hospitalization, 16.0 and 9.3 for CHD, 9.3 and 8.2 for stroke, and 55.0 and 37.1 for all-cause mortality, respectively. After multivariable adjustment for sociodemographic variables and cardiovascular risk factors, hazard ratios (95% CI) comparing participants with versus without gout were 1.97 (1.22, 3.19) for HF hospitalization, 1.21 (0.79, 1.84) for CHD, 0.83 (0.48, 1.43) for stroke, and 1.08 (0.86, 1.35) for all-cause mortality. The multivariable-adjusted hazard ratio for HF hospitalization with reduced and preserved left ventricular ejection fraction among participants with versus without gout was 1.77 (95% CI 0.83, 3.79) and 2.32 (95% CI 1.12, 4.79), respectively. The multivariable-adjusted hazard ratio for heart failure hospitalization associated with gout among the 839,059 Medicare beneficiaries was 1.32 (95% CI 1.25, 1.39).
CONCLUSION
Among older adults, gout was associated with an increased risk for incident HF but not for incident CHD, incident stroke, or all-cause mortality.
背景
一些先前的研究表明，痛风与冠心病（CHD）和中风的风险增加有关。很少有研究评估痛风与心力衰竭（HF）发病之间的关系。
方法
我们分析了年龄在 65.5 岁及以上的、来自基于人群的 Reasons for Geographic And Racial Differences in Stroke（REGARDS）队列研究的 5713 名黑人和白人男性和女性的数据，这些人在基线时有医疗保险，但没有心力衰竭、CHD 或中风病史，医疗保险覆盖范围从 2003 年到 2007 年。痛风通过≥1 次住院或≥2 次门诊就诊来定义，医疗保险索赔中有痛风的诊断代码。REGARDS 研究参与者在基线研究检查后被分别随访 HF 住院、CHD、中风和全因死亡率。分析结果在 839059 名年龄在 65.5 岁及以上的、有医疗保险的患者中进行了复制，这些患者的医疗保险覆盖范围从 2008 年 1 月 1 日至 2015 年 6 月 30 日，随访至 2017 年 12 月 31 日。
结果
在当前分析纳入的 REGARDS 研究参与者中，基线时的平均年龄为 72.6 岁，44.9%为男性，31.4%为黑人，3.3%患有痛风。在中位数为 10.0 年的随访中，患有和不患有痛风的参与者的每 1000 人年的发病率分别为 13.1 和 4.4 的 HF 住院率，16.0 和 9.3 的 CHD，9.3 和 8.2 的中风，55.0 和 37.1 的全因死亡率。经过多变量调整社会人口统计学变量和心血管危险因素后，与不患有痛风的参与者相比，患有痛风的参与者的 HF 住院率的风险比（95%CI）为 1.97（1.22，3.19），CHD 为 1.21（0.79，1.84），中风为 0.83（0.48，1.43），全因死亡率为 1.08（0.86，1.35）。与不患有痛风的参与者相比，患有痛风的参与者 HF 住院率的多变量调整风险比在左心室射血分数降低和保留的参与者中分别为 1.77（95%CI 0.83，3.79）和 2.32（95%CI 1.12，4.79）。与痛风相关的 HF 住院率的多变量调整风险比在 839059 名医疗保险受益人中为 1.32（95%CI 1.25，1.39）。
结论
在老年人中，痛风与 HF 发病风险增加有关，但与 CHD、中风发病或全因死亡率无关。
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