Women with Gout Face Higher Risk of Acute Myocardial Infarction

Study results published online ahead of print in Annals of the Rheumatic Diseases indicate that women with gout face a greater risk of acute myocardial infarction (AMI) than do men who have been diagnosed with gout.

The authors of this population-based cohort study used data from the British Columbia Linked Health Database and “compared incidence rates of AMI between 9,642 gout patients and 48,210 controls, with no history of ischaemic heart disease.” Nearly 4,000 (3,889) of the subjects with gout were women; 19,450 of the controls were women. Subjects with gout and controls were matched by age, sex, date of gout diagnosis, and length of medical record.

The authors reported gout incident rates of 5.7 (per 1,000 person-years) in men aged 65-84 and 6.5 in men older than 85; rates among women were 2.5 and 2.9, respectively, for those age groups. Incidence rates (per 1,000 person-years) for AMI in this cohort were 6.7 and 10.7 for women and men, respectively.

Seven-year median follow up produced 3,268 incident AMI cases (996 women). Analysis indicated that “gout was associated with a higher risk of AMI (RR=1.67; 95% CI, 1.45 to 1.93) among women.” Relative risk, adjusted for age, comorbidities, and prescription drug use, for AMI was 1.39-times higher in women with gout compared to women without the disease. Relative risk for men with gout was only 1.1-times higher than in men without gout.

The authors report a “39% increased risk for AMI among women with gout,” an association that was “independent of age, comorbidities and use of prescription drugs, and was significantly stronger than that among men.”

According to this study, “Gender differences in serum uric acid levels and perhaps uric acid metabolism may explain the stronger risk of AMI associated with gout among women than among men.” Reasons for this difference in relative risk may be explained by a higher level of uric acid among women with gout, which “could lead to a higher impact on the risk of AMI compared with men.”

Based on these findings, the authors conclude that “this population-based study suggests that women with gout have an increased risk for AMI, and the magnitude of excess risk is higher than for men. These findings provide support for the aggressive management of cardiovascular risk factors for male and female patients with gout.”