Lee Da Young, Moon Jun Sung, Jung Inha, Chung Seung Min, Park So Young, Yu Ji Hee, Seo Ji A, Han Kyung-do, Kim Nan Hee
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Diabetes Obes Metab. 2025 Mar;27(3):1554-1563. doi: 10.1111/dom.16165. Epub 2025 Jan 2.
We aimed to examine the impact of gout on cardiovascular disease (CVD) and mortality risk in patients with type 2 diabetes and explore whether chronic kidney disease (CKD) modifies this association.
Using the Korean National Health Insurance Service database, 757 378 individuals with type 2 diabetes were classified into the CKDGout, CKDGout, CKDGout, and CKDGout groups. Cox proportional hazard models were used to assess the risk of myocardial infarction (MI), ischemic stroke, and mortality, after adjusting for cardiometabolic factors.
Over a median follow-up of 9.3 years, 25 618, 38 691, and 78 628 individuals experienced MI, stroke, and mortality, respectively. The risk of MI or stroke progressively increased across the groups, with the highest adjusted hazard ratio (HR) in the CKDGout group (HR: 1.57, 95% confidence interval [CI]: 1.46-1.69), followed by the CKDGout group (HR: 1.23, 95% CI 1.20-1.26). The CKDGout group showed the greatest risks for MI (HR: 1.71), stroke (HR: 1.46), and mortality (HR: 1.78). Individuals with gout alone did not exhibit a significant increase in risk compared with those without gout or CKD. Interaction analyses indicated that the effect of gout on the outcomes was more pronounced in patients with CKD. Subgroup analyses yielded consistent findings across diverse demographic and clinical characteristics.
CKD with or without gout increased the risk of CVD and mortality, with the highest risk observed in the CKDGout group. The interaction between CKD and gout significantly influenced these outcomes.
我们旨在研究痛风对2型糖尿病患者心血管疾病（CVD）及死亡风险的影响，并探讨慢性肾脏病（CKD）是否会改变这种关联。
利用韩国国民健康保险服务数据库，将757378例2型糖尿病患者分为CKD痛风组、CKD痛风组、CKD痛风组和CKD痛风组。在对心血管代谢因素进行校正后，采用Cox比例风险模型评估心肌梗死（MI）、缺血性中风和死亡风险。
在中位随访9.3年期间，分别有25618例、38691例和78628例患者发生MI、中风和死亡。MI或中风风险在各组中逐渐增加，CKD痛风组校正后风险比（HR）最高（HR：1.57，95%置信区间[CI]：1.46 - 1.69），其次是CKD痛风组（HR：1.23，95%CI 1.20 - 1.26）。CKD痛风组在MI（HR：1.71）、中风（HR：1.46）和死亡（HR：1.78）方面风险最高。单纯痛风患者与无痛风或CKD患者相比，风险未显著增加。交互分析表明，痛风对结局的影响在CKD患者中更为显著。亚组分析在不同人口统计学和临床特征中得出了一致的结果。
伴有或不伴有痛风CKD均增加了CVD和死亡风险，CKD痛风组风险最高。CKD与痛风之间的相互作用显著影响了这些结局。
