痛風和心血管疾病風險增加有關


  【24drs.com】根據線上發表於8月27日風濕病學誌的一篇研究,痛風患者,特別是女性,心血管疾病風險增加。
  
  英國Keele大學基礎照護與健康科學研究院的Lorna E. Clarson醫師等人寫道,痛風的生化前兆、高尿酸血症,與冠狀動脈心臟病[coronary heart disease,CHD]和中風的發生率及死亡率增加有關,雖然痛風在傳統上被視為是一種間歇性發炎狀況,最近有超音波研究顯示,在兩次急性發作之間,有持續的次臨床發炎現象,研究者假設,持續的發炎加上高尿酸血症會加強或協同發生CHD。
  
  Clarson醫師等人對一群接受初級照護的痛風患者,檢視了痛風和發生CHD、腦血管疾病[cerebrovascular disease,CVD]、周邊血管疾病[peripheral vascular disease,PVD]的關聯。
  
  他們共檢視了「臨床應用研究資料集連結」資料庫的8,386名痛風患者,根據他們的年紀、性別、就診的一般科別和39,766名對照組進行配對。全部患者和對照組年紀都是50歲以上,之前都沒有血管病史。採用Multivariable Cox回歸方式估計發生痛風或配對指標日期(開始日)之後10年的風險比[HRs],共變項包括性別、開始時年紀、身體質量指數、抽菸、喝酒、Charlson共病症指數、高血壓、高血脂、慢性腎病等病史、使用statin或阿斯匹靈等藥物。
  
  與沒有痛風的男性相比,有痛風的男性發生任何血管事件的風險略為顯著增加(風險比[HR]為1.06;95%信心區間[CI]為1.01 - 1.12)。同樣地,有痛風的男性發生任何CHD(HR,1.08;95% CI,1.01 - 1.15)和PVD (HR,1.18;95% CI,1.01 - 1.38)的風險也比較大。
  
  至於有痛風的女性,任何血管事件風險比沒有痛風的女性高25%(HR,1.25;95% CI,1.15 - 1.35)。任何CHD (HR,1.25;95% CI,1.12 -1.39)和PVD (1.89;95% CI,1.50 - 2.38)的風險也比較高,但是,研究者發現,任何的CVD事件方面則無差異。
  
  此外,有痛風的女性,心絞痛、暫時性缺血性發作、中風的風險增加。
  
  研究者寫道,在這些有痛風的50歲以上患者,校正血管風險因素之後,即便男性的痛風和血管疾病發生率較高,女性痛風病患發生血管事件的風險最大。
  
  研究限制包括,使用診斷碼分析可能會有錯誤分類偏差、可能有其他干擾因素、無法校正高尿酸血症。
  
  研究者結論指出,需要後續研究以建立痛風患者在血管風險因素和痛風本身的長期適當處置方式,釐清痛風和PVD之關聯的本質,以及為何女性風險最大之機轉。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7111&x_classno=0&x_chkdelpoint=Y
  

Gout Linked to Increased Vascular Disease Risk

By Laurie Barclay, MD
Medscape Medical News

Patients with gout, particularly women, have increased risk for vascular disease, according to findings of a study published online August 27 in the Annals of Rheumatic Diseases.

"Hyperuricaemia, the biochemical precursor to gout, has been linked with an increased incidence of, and mortality from, both [coronary heart disease (CHD)] and stroke," write Lorna E. Clarson, MBChB, from the Research Institute for Primary Care & Health Sciences at Keele University in the United Kingdom, and colleagues. "Although gout is traditionally thought of as an intermittent inflammatory condition, recent ultrasound studies have identified persistent subclinical inflammation in the intercritical period between acute attacks. It has been hypothesised that the combination of persistent inflammation and hyperuricaemia may potentiate or synergise CHD development."

Dr. Clarson and colleagues examined the association of gout with incident CHD, cerebrovascular disease (CVD), and peripheral vascular disease (PVD) in a large cohort of primary care patients with gout.

They identified 8386 patients with gout who were enrolled in the Clinical Practice Research Datalink and matched them on the basis of age, sex, and registered general practice, with 39,766 control participants. All patients and matched participants were older than 50 years and had no previous vascular history. Multivariable Cox regression allowed estimation of hazard ratios (HRs) in the 10 years after incidence of gout or matched index date (baseline), using covariates of sex, baseline age, body mass index, smoking, alcohol drinking, Charlson comorbidity index, history of hypertension, hyperlipidemia, chronic kidney disease, statin use, and aspirin use.

Men with gout had a small but significantly elevated risk for any vascular event (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01 - 1.12) compared with men without gout. Similarly, men with gout had a greater risk for any CHD (HR, 1.08; 95% CI, 1.01 - 1.15) and PVD (HR, 1.18; 95% CI, 1.01 - 1.38).

Among women with gout, the risk for any vascular event was 25% higher than among women without gout (HR, 1.25; 95% CI, 1.15 - 1.35). Their risk for any CHD (HR, 1.25; 95% CI, 1.12 - 1.39) and PVD (1.89; 95% CI, 1.50 - 2.38) was also higher, but the researchers found no difference for risk for any CVD.

In addition, women with gout, but not men with gout, were at increased risk for angina, transient ischemic attack, and stroke.

"In this cohort of over 50s with gout, female patients with gout were at greatest risk of incident vascular events, even after adjustment for vascular risk factors, despite a higher prevalence of both gout and vascular disease in men," the study authors write.

Limitations of this study include possible misclassification bias from the use of diagnostic codes, possible residual confounding, and inability to adjust for hyperuricemia.

"Further work is required to establish the effect of optimum management of both vascular risk factors and gout itself on the long-term health of gout patients, clarify the nature of the relationship between gout and PVD, and the mechanism by which women are at greatest risk," the study authors conclude.

The National School for Primary Care Research funded this study. The senior author is funded by an Arthritis Research UK Clinician Scientist Award. The other authors have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online August 27, 2014.

    
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