Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
Atherosclerosis. 2020 Nov;312:23-27. doi: 10.1016/j.atherosclerosis.2020.08.029. Epub 2020 Sep 8.
Prior epidemiological studies have suggested that individuals with gout are at greater risk of cardiovascular events, but there have been no studies in people with peripheral artery disease (PAD). The aim of this study was to investigate the relationship between gout and major adverse cardiovascular events (MACE) and all-cause mortality in people with PAD.
Participants with a range of PAD presentations, including carotid artery disease, aortic or peripheral aneurysm and lower limb PAD, were prospectively recruited from outpatient vascular departments within Australia. MACE (myocardial infarction, stroke or cardiovascular death) and all-cause mortality were identified through out-patient follow-up and linked medical records. Propensity-score matching was undertaken to generate a matched cohort of patients with and without a history of gout. Kaplan-Meier survival analysis and Cox-proportional hazard analysis were used to examine the association of gout with MACE and all-cause mortality.
A total of 4308 people with PAD, of whom 334 had a history of gout, were included and followed for a median (inter-quartile range) of 2.1 (0.1-5.9) years. In the unadjusted analyses, participants with gout were at increased risk of MACE (hazard ratio, HR 1.37, 95% confidence intervals, CI 1.09-1.71, p = 0.006) and all-cause mortality (HR 1.38, 95% 1.13-1.68, p = 0.002), however, the associations were lost in the adjusted analyses. In the propensity-score matched cohort, gout was not significantly associated with an increased risk for MACE or all-cause mortality.
Gout was not independently associated with increased cardiovascular events in PAD patients.
先前的流行病学研究表明，痛风患者发生心血管事件的风险更高，但针对外周动脉疾病（PAD）患者尚无相关研究。本研究旨在探讨痛风与 PAD 患者的主要不良心血管事件（MACE）和全因死亡率之间的关系。
本前瞻性研究从澳大利亚门诊血管科招募了多种 PAD 表现（包括颈动脉疾病、主动脉或外周动脉瘤以及下肢 PAD）的患者。通过门诊随访和查阅病历记录确定 MACE（心肌梗死、卒中和心血管死亡）和全因死亡率。采用倾向评分匹配生成了一组痛风史患者和无痛风史患者的匹配队列。使用 Kaplan-Meier 生存分析和 Cox 比例风险分析来评估痛风与 MACE 和全因死亡率之间的关联。
共纳入 4308 例 PAD 患者，其中 334 例有痛风史，中位（四分位距）随访时间为 2.1（0.1-5.9）年。在未校正分析中，痛风患者发生 MACE 的风险增加（风险比 1.37，95%置信区间 1.09-1.71，p=0.006）和全因死亡率（风险比 1.38，95%置信区间 1.13-1.68，p=0.002），但在校正分析中，相关性消失。在倾向评分匹配的队列中，痛风与 MACE 或全因死亡率的增加无关。
痛风与 PAD 患者的心血管事件增加无关。
