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.

References

1. Keenan R, et al. Etiology and pathogenesis of hyperuricemia and gout. Kelley's textbook of rheumatology. Elsevier Saunders. 2013;94:1533–53.

2. Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2016:annrheumdis-2016-209707.

3. Lottmann K, et al. Association between gout and all-cause as well as cardiovascular mortality: a systematic review. Curr Rheumatol Rep. 2012;14(2):195–203.

4. Clarson L, et al. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015;22(2):335–43.

References

Disclosure of Interest S. Mitchell: None declared, H. Liedgens Employee of: Grünenthal GmbH, E. Johannes Employee of: Grünenthal GmbH