Rheumatology Advance Access originally published online on August 18, 2008
Rheumatology 2008 47(10):1567-1570; doi:10.1093/rheumatology/ken305
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© Published by Oxford University Press on behalf of the British Society for Rheumatology 2008.
Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile
1Department of Medicine, Division of Rheumatology, Vancouver General Hospital, 2Arthritis Research Centre of Canada, 3Department of Health Care and Epidemiology, Vancouver, BC, Canada and 4Department of Medicine, Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA.
Correspondence to: H. K. Choi, Department of Medicine, Division of Rheumatology, University of British Columbia, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada. E-mail: hchoi{at}partners.org
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Abstract |
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Objective. Our objective was to evaluate the independent relation between a history of gout and the future risk of type 2 diabetes among men with a high cardiovascular risk profile.
Methods. We prospectively examined over a 6-yr period the relation between gout and the risk of incident type 2 diabetes in 11 351 male participants from the Multiple Risk Factor Intervention Trial (MRFIT). Incident diabetes was defined based on the American Diabetes Association (ADA) criteria for epidemiological studies. Cox proportional hazards regression was used to adjust for potential confounders.
Results. We documented 1215 new cases of type 2 diabetes. After adjusting for age, BMI, smoking, family history of type 2 diabetes, alcohol intake, dietary factors and presence of individual components of the metabolic syndrome, the multivariate relative risk (RR) for incident type 2 diabetes among men with gout at baseline, as compared with men without gout, was 1.34 (95% CI 1.09, 1.64). When we further adjusted for serum uric acid levels, the association remained significant (RR 1.26; 95% CI 1.02, 1.54). When we updated the status of gout annually during follow-up as a time-varying covariate, the association remained similar. The association also remained similar in our subgroup analyses by major covariates (P-values for interaction >0.16).
Conclusions. These findings from men with a high cardiovascular risk profile suggest that men with gout are at a higher future risk of type 2 diabetes independent of other known risk factors. These data expand on well-established, cross-sectional associations between hyperuricaemia, gout and the metabolic syndrome, and extend the link to the future risk of type 2 diabetes.
KEY WORDS: Uric acid, Gout, Diabetes, Insulin, Metabolic syndrome
Submitted 21 April 2008; Accepted 3 July 2008
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