Hypertension and the Risk of Incident Gout in a Population-Based Study: The Atherosclerosis Risk in Communities Cohort

Authors

  • Mara A. McAdams-DeMarco MS, PhD,

    1. From the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 1 and the Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD 2
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  • 1 Janet W. Maynard MD, MHS,

    1. From the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 1 and the Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD 2
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  • 2 Alan N. Baer MD,

    1. From the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 1 and the Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD 2
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  • and 2 Josef Coresh MD, PhD 1

    1. From the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 1 and the Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD 2
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Mara A. McAdams-DeMarco, MS, PHD, 2024 East Monument Street, Suite B-319, Baltimore, MD 21287
E-mail:mmcadams@jhsph.edu

Abstract

J Clin Hypertens (Greenwich). 2012; 14:675–679. ©2012 Wiley Periodicals, Inc.

The authors quantified the impact of hypertension on gout incidence in middle-aged white and African American men and women. The Atherosclerosis Risk in Communities Study (ARIC) was a prospective population-based cohort that recruited patients between 1987 and 1989 from 4 US communities. Using a time-dependent Cox proportional hazards model, the authors estimated the adjusted hazard ratio (HR) of incident gout by time-varying hypertension and tested for mediation by serum urate level. There were 10,872 participants among whom 45% had hypertension during follow-up; 43% were men and 21% were African American. Over 9 years, 274 (2.5%) participants developed gout (1.8% of women and 3.5% of men). The unadjusted HR of incident gout was approximately 3 times (HR, 2.87; 95% confidence interval [CI], 2.24–3.78) greater for those with hypertension. Adjusting for confounders resulted in an attenuated but still significant association between hypertension and gout (HR, 2.00; 95% CI, 1.54–2.61). Adjustment for serum urate level further attenuated but did not abrogate the association (HR, 1.36, 95% CI, 1.04–1.79). There was no evidence of effect modification by sex (P=.35), race (P=.99), or obesity at baseline (P=.82). Hypertension was independently associated with increased gout risk in middle-aged African American and white adults. Serum urate level may be a partial intermediate on the pathway between hypertension and gout.

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