Vitamin D Associated With Lower Risk of Mortality in Patients With Gout, Hyperuricemia

A new study has found a negative correlation between serum vitamin D and mortality in patients with gout and a U-shaped relationship in patients with hyperuricemia (HUA).¹

“Though there are several major advances in gout treatment, including anti-inflammatory drugs, synthetic adrenocorticotropic hormone, oral colchicine, studies have shown that gout patients have a 17% increased risk of mortality than general population, thus determining the controllable causes is vitally important to reduce complications and mortality among patients with gout and hyperuricemia,” first author Ke Liu, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, and coauthors wrote.¹

Liu and other researchers from Zhejiang Chinese Medical University analyzed data from 1169 people with gout and 7029 people with HUA from the National Health and Nutrition Examination Survey (NHANES), from 2007–2018 and 2001–2018, respectively. They used Cox proportional hazard and restricted cubic spline models to analyze associations between serum 25-hydroxyvitamin D (25[OH]D) and mortality.

The investigators found that participants with gout had a weighted serum 25(OH)D mean concentration of 71.49 ± 30.09 nmol/L and participants with HUA had a weighted serum 25(OH)D mean concentration of 64.81 ± 26.92 nmol/L. Around a third of participants with gout (29.68%) and HUA (37.83%) had vitamin D deficiency.¹

With a total of 6783 person-years of follow-up in participants with gout, there were 248 all-cause deaths, including fatalities due to cardiovascular disease (CVD; n =76) and cancer (n = 49). With a total of 59,859 person-years of follow-up in participants with HUA, there were 1375 all-cause mortalities, including fatalities due to CVD (n = 427) and cancer (n = 232).¹

Liu and coauthors found that, after multifactorial adjustment, per one-unit increment in natural log-transformed 25(OH)D was associated with a 55% lower risk in all-cause mortality and a 61% lower risk of CVD mortality in patients with gout (both P ≤.003). In patients with HUA, they found a 45% lower risk of cancer mortality (P = .009). Furthermore, restricted cubic splines revealed a U-shaped relationship with all-cause and CVD mortality in patients with HUA with inflection points of 72.7 nmol/L and 38.0 nmol/L, respectively (both P ≤.003). The data trends were corroborated by subgroup and sensitivity analyses, although not always to statistical significance.¹

“Given that HUA is a chronic metabolic disease caused by purine metabolism disorders, the management of serum 25(OH)D should receive more attention. Therefore, our findings can help us to accurately identify the mortality risk of patients with gout and HUA in clinical practice and is conducive to the development of personalized treatment plans. and further confirmation was still needed in large clinical trials,” Liu and coauthors wrote.¹

One large limitation of the study was the self-reporting of gout with no other diagnostic tests. Another was the limited statistical power of the study to detect the association between serum vitamin D and cancer-specific mortality due to the relatively small number of cancer-related deaths.

In other similar news, another recent retrospective analysis, performed out of University of Virginia School of Medicine, found that primary total hip arthroplasty was linked to an increased risk of multiple medical complications, including deep vein thrombosis and acute kidney injury, as well as surgical complications, including wounds and periprosthetic joint infection in patients with gout.²

REFERENCES

1. Liu K, Lu X, Wang A, et al. Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with gout and hyperuricemia. Nutr J 23. (2024);89. https://doi.org/10.1186/s12937-024-00992-8
2. Zhang Z, Yang H, Xu Z, Chi J, Cui Q. Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts. Clin Orthop Surg. 2024;16(4):542-549. doi:10.4055/cios24039