Background While alcohol is a well-established risk factor for gout, many prospective studies have consistently found that moderate alcoholic consumption is associated with a 25–40% reduced risk for coronary heart disease (CHD) and death. As such, the American Heart Association (AHA) suggests that “if you drink alcohol, do so in moderation”. As gout is associated with an increased risk of CHD and premature mortality, the potential benefits of drinking in moderation may also be applicable to gout patients provided that their gout is under control with other measures.
Objectives To examine the relation between alcohol intake and the risk of acute myocardial infarction (AMI) and all-cause mortality among incident gout patients in a general population context.
Methods We conducted a cohort study using data from an electronic medical record database representative of the UK general population, collected between 1995 and 2015. The exposure of interest was the first alcohol intake measured after gout diagnosis, and our endpoints were incident cases of AMI as well as all-cause mortality. Stratifying by sex, we calculated the hazard ratios (HR) of these endpoints according to alcohol intake categories (i.e., 0, 1–9, 10–24, 25–42, and >42 UK alcohol units/week [1 unit=8gm]), adjusting for age, smoking status, body mass index, duration of gout, comorbidities, and medication use. We performed a spline model analysis using 4 knots of the alcohol intake categories, hypothesizing a J-shaped relation as observed in general population studies.
Results Among 55,584 gout patients (78% male, mean age of 63 years), 1,332 developed AMI and 8,362 died over a mean follow-up of 5.6 years. Compared with men who did not drink alcohol after gout onset, men who drank alcohol had a lower risk of AMI as well as mortality in a J-shaped manner (Figure 1, left panel). The multivariable HRs for developing AMI were 1.0, 0.76 (95% confidence interval [CI], 0.63–0.93), 0.68 (0.55–0.83), 0.69 (0.53–0.89), and 0.71 (0.52–0.95) for alcohol use categories of 0, 1–9, 10–24, 25–42, and >42 units/week, respectively, and the corresponding HRs for mortality were 1.0, 0.77 (95% CI, 0.71–0.82), 0.71 (0.66–0.77), 0.74 (0.66–0.82), and 0.89 (0.78–1.01) (Figure 1, left panel). While alcohol consumption levels and sample sizes were smaller among women, the J-shaped relation was more obvious and showed a significantly increased risk of mortality in the top consumption category (HR=1.68; 95% CI, 1.09–2.61) (Figure 1, right panel).
Conclusions This general population-based study indicates that moderate alcohol intake is associated with a lower risk of AMI as well as all-cause mortality among gout patients, similar to many general population studies. These findings suggest that the AHA recommendation about moderate alcohol use may also be applicable to gout patients for their cardiac health and improved survival, provided that their gout is under control with other measures.
Acknowledgements This project was supported in part by NIH grant P60-AR-047785 and NIH grant R01-AR-065944.
Disclosure of Interest None declared