Modifiable risk factors and incident cardiovascular events in gout patients

Abstract Background Gout is associated with increased risks of cardiovascular events. However, it remains uncertain whether achieving the control targets for risk factors can attenuate this risk. This study evaluated the association between the attainment of targeted seven risk factors and the incidence of major adverse cardiovascular events (MACCE) among patients with gout. Methods From the UK Biobank database, we analyzed data from participants diagnosed with gout at baseline (2006-2010). These individuals were followed to monitor the incidence of MACCE. Gout patients were stratified based on the achievement of seven predefined risk factor targets at baseline: body mass index 18.5-24.9, adherence to a high-quality diet, engagement in regular exercise, non-smoking status, abstention from alcohol, hemoglobin A1c <48 mmol/mol, and serum urate < 360 μmol/L. The primary outcome was the incidence of MACCE, encompassing all-cause death, stroke, or myocardial infarction. Cox model was used to identify independent predictors of MACCE. Results After a median follow-up of 14.1 years, 1,318 of 6,273 gout patients developed MACCE. Among individuals with gout, the risk of MACCE decreased stepwise with the number of optimally managed modifiable risk factors. For participants exhibiting 1, 2, 3, and ≥4 optimal modifiable factors, the hazard ratios (HRs) were 0.39 (95% confidence interval (CI): 0.26-0.58), 0.30 (95%CI: 0.20-0.44), 0.28 (95%CI: 0.19-0.41), and 0.24 (95%CI: 0.16-0.36) respectively, showing a significant trend towards risk reduction (Ptrend <0.001). Conclusion Among individuals with gout, there is a stepwise decrease in the risk of MACCE with every additional risk factor that is optimally controlled.Study flowStratified analysis for adjusted HRs