Background Gout is a chronic, progressive, inflammatory disease characterised by elevated serum uric acid (sUA) levels (1). In Europe the prevalence of gout ranges from 0.9–2.5%, and is increasing (2). Published data indicate that gout is an independent risk factor for both all-cause and cardiovascular (CV)-related mortality (3, 4).
Objectives To conduct a systematic review to identify studies reporting the association between gout and mortality (all-cause and CV-related).
Methods Relevant publications were identified by interrogating electronic databases; Medline & MEDLINE In-Process, EMBASE and the Cochrane Library (accessed 3 May 2016). Eligibility criteria included adult patients with a definitive diagnosis of acute/chronic gout (self-reported/physician diagnosed), with no restriction on publication date, study design or geography.
Results Nineteen studies met the pre-defined inclusion criteria and were reviewed. The studies were conducted in: the US (n=8); Taiwan (n=5); Canada (n=3); Spain (n=1); Singapore (n=1); and the UK (n=1). In addition to patients having a diagnosis of acute/chronic gout, 6 of the 19 studies were conducted in the following patient subgroups: renal transplant (n=1); chronic kidney disease (n=2); patients with a recent acute myocardial infraction (n=2); and patients with heart failure (n=1). There were several consistent finding across the 19 studies: (i) gout was associated with an increase in both all-cause mortality (reported hazard ratios [HR] ranged from 1.13 to 2.37) and CV-related mortality (reported HR ranged from 1.10 to 3.88) compared with patients without gout; (ii) the increased risk in all-cause mortality was primarily driven by an increase in CV-related mortality; (iii) the increased mortality risk was higher in females than males. One study reported that the presence of tophi was independently associated with a higher risk of all-cause mortality. Notably one study reported that patients who received urate-lowering therapy (ULT) have a statistically significant lower all-cause mortality and CV-related mortality risk relative to patients who do not receive ULT.
Conclusions This systematic review confirms that gout is associated with an increased risk of all-cause and CV-related mortality; this was consistently reported across the eligible studies. The findings highlight the risk associated with gout and emphasise the need for appropriate treatment of this curable disease.
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Disclosure of Interest S. Mitchell: None declared, H. Liedgens Employee of: Grünenthal GmbH, E. Johannes Employee of: Grünenthal GmbH