Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Risk Factors for Incident Gout Among Women: A Prospective Study

Bhole1,  Vidula, De Vera1,  Mary, Rahman1,  M. Mushfiqur, Krishnan2,  E., Choi3,  Hyon K.

Arthritis Research Centre of Canada, Vancouver, BC,
Stanford University School of Medicine, Palo Alto, CA,
Boston University School of Medicine, Boston, MA

Purpose:

Despite recent doubling of the incidence of gout among women and substantial prevalence particularly in the aging female population, little data are available on the risk factors for gout among women. Given the important gender differences in uric acid metabolism, role of sex hormones, and frequency of gout, the risk factors for gout may vary considerably between genders. We examined the relation between serum uric acid level, purported risk factors and the risk of incident gout among women in the Framingham Heart Study (FHS) cohort.

Methods:

Using data from FHS (1950–2002), we prospectively examined the relation between uric acid, purported risk factors and incidence of gout in 2,476 women and 1,951 men. We calculated the incidence rates of gout according to uric acid categories. We used Cox proportional hazards model with time-dependent variables to estimate the relative risk (RR) for incident gout by age, education, obesity, hypertension, diuretic use, alcohol use, glucose and cholesterol level, and menopausal status. We explored potential interaction by gender by testing significance of interaction terms added to our final multivariate models.

Results:

At baseline mean age of the cohort was 47 years and 50% women were postmenopausal. Mean baseline uric acid level was 4.5 mg/dL for the cohort; and 4.0 mg/dL for women. The proportion of individuals with obesity, hypertension, diuretic use, and heavy alcohol use were 13%, 13%, 4% and 14% respectively; and for women 14%, 15%, 6%, and 6%, respectively. Over 28 year median follow-up, we documented 304 incident gout cases, 104 in women. Incidence rates of gout for women per 1000 person years for uric acid levels of <5.0, 5.0–5.9, 6.0–6.9, 7.0–7.9 and >=8.0 mg/dL were 0.8, 2.5, 4.2, 13.1, and 27.3, respectively (p for trend <0.0001). The magnitude of this association was significantly lower than that among men (p for interaction, 0.0002). The associations of purported risk factors and incident gout were similar between genders (Table), except for a stronger age effect among women (p for interaction, 0.02)

 Multivariate RR
 WomenMen
Age, per 5 yr1.24 (1.08, 1.43)1.14 (1.03, 1.26)
BMI, kg/m2  
<251.01.0
25–301.44 (0.88, 2.37)1.76 (1.22, 2.54)
>=302.74 (1.65, 4.58)2.90 (1.89, 4.44)
Diuretics  
No1.01.0
Yes2.39 (1.53, 3.74)3.41 (2.38, 4.89)
Alcohol  
Light1.01.0
Moderate1.30 (0.80, 2.12)1.44 (0.99, 2.08)
Heavy3.10 (1.69, 5.68)2.21 (1.56, 3.14)
Hypertension  
No1.01.0
Yes1.82 (1.06, 3.14)1.59 (1.12, 2.24)
Glucose, per 10 mg/dL1.02 (0.98, 1.07)0.99 (0.95, 1.03)
Cholesterol, per 10 mg/dL0.99 (0.95, 1.04)1.03 (0.99, 1.06)
Education, grades  
<121.01.0
121.05 (0.67, 1.66)0.86 (0.59, 1.24)
>120.58 (0.34, 1.02)1.12 (0.81, 1.56)
Menopause  
No1.0-
Yes3.54 (0.46, 27.15)-

Conclusion:

Higher levels of serum uric acid increase the risk of gout in a graded manner among women, but the rate of increase is lower than that among men. The latter finding appears to provide another reason behind the lower background incident rates of gout among women that goes beyond their lower baseline serum uric acid levels. Age, obesity, hypertension, alcohol consumption, and diuretic use were associated with the risk of incident gout among women.

To cite this abstract, please use the following information:
Bhole, Vidula, De Vera, Mary, Rahman, M. Mushfiqur, Krishnan, E., Choi, Hyon K.; Risk Factors for Incident Gout Among Women: A Prospective Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :2037
DOI: 10.1002/art.27109

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