Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Thiazide and Loop Diuretics Are Associated with Incident Gout in the Atherosclerosis Risk in Communities (ARIC) Study.

McAdams4,  Mara A., Maynard2,  Janet W., Gelber1,  Allan C., Baer3,  Alan N., Coresh4,  Josef

Baltimore, MD
Johns Hopkins Univ, Baltimore, MD
Johns Hopkins University, Baltimore, MD
Johns Hopkins, Bloomberg School of Public Health

Background:

While there is a clear association between diuretic use and the development of gout, it is unclear whether both thiazide and loop diuretics are associated with an increased incidence of gout. We quantified the association between incident gout and diuretic use, type of diuretic.

Methods:

ARIC is a prospective population-based cohort study of 15,792 individuals recruited in 1987–1989 from four US communities. It consists of 1 baseline visit (visit 1) and 3 follow-up visits administered 3 years apart. At ARIC visit 4, participants were asked, "Has a doctor ever told you that you had gout?" Participants were excluded if they did not attend visit 4 or had gout prior to visit 1. At baseline, blood pressure values were measured. Participants were asked to bring all medications that they had taken in the past 2 weeks to the baseline visit. Medication data, including diuretic use and class, were obtained by trained interviewers reviewing prescription bottles. Hypertension (HTN) was defined by the report of a medication to treat HTN or a blood pressure measurement > 140/90 mm Hg.

We examined whether baseline diuretic use was associated with incident gout over 9 years of follow-up. We used logistic regression to calculate the odds of incident gout associated with diuretic use in the whole population and the subset with baseline HTN. All models were adjusted for age, sex, race, HTN and baseline body mass index, estimated glomerular filtration rate, diabetes, and protein and alcohol intake. The models for loop diuretics were also adjusted for CHF diagnosis.

Results:

There were 10,872 participants who met the study criteria; 1,643 (15%) took a diuretic, 3,248 (30%) had HTN at baseline and 43% of the HTN patients were taking a diuretic. The study population was 57% female and 22% African-American. There were 286 gout cases. Per 1000 participants, the cumulative incidence of gout was 28 overall, 61 among those who reported diuretic use in the 2 weeks prior to the baseline visit, 21 for those not exposed to a diuretic, and 51 for those with HTN. Baseline use of any diuretic, including thiazide and loop diuretics, was associated with an approximately 2-fold increased risk of incident gout, after adjustment for confounders. Among the participants with HTN, the risk of gout was increased approximately 1.5-fold compared to non-diuretic users. Results were similar by sex and race, except for the association of loop diuretics (African-America, Adjusted OR=0.76, not significant) and (White, Adjusted OR= 3.6, p-value< 0.001).

Table. Odds of gout by diuretic use and class

 Participants using diuretics (n=1,549) vs. participants not using diuretics, n=10,872 with 286 incident gout cases
 Any diuretic useThiazideLoop
Gout944416
No Gout1,549799158
Unadjusted OR2.87 (2.23, 3.69)2.24 (1.61, 3.11)3.91 (2.30, 6.62)
Age adjusted OR2.85 (2.21, 3.68)2.21 (1.59, 3.08)3.86 (2.28, 6.55)
Fully adjusted OR2.26 (1.70, 3.00)1.93 (1.35, 2.74)2.14 (1.11, 4.14)
 Participants with hypertension using diuretics (n=1,299) vs. participants not using diuretics, n=3,248 with 165 incident gout cases
 Any diuretic useThiazideLoop
Gout864311
No gout1,29969395
Unadjusted OR1.50 (1.09, 2.05)1.22 (0.85, 1.74)2.25 (1.18, 4.28)
Age adjusted OR1.50 (1.10, 2.06)1.22 (0.85, 1.74)2.27 (1.19, 4.33)
Fully adjusted OR1.49 (1.06, 2.10)1.44 (0.99, 2.10)1.29 (0.57, 2.93)
Note: OR refers to odds ratios and we presented 95% Confidence Intervals. We did not calculate odds ratios for the exposure to thiazide diuretics because there was only one exposed case.

Conclusion:

Our results suggest that diuretic use is associated with incident gout. Thiazide and loop diuretics were associated with twice the risk of gout. This study supports the previously reported association of diuretic use with gout and suggests that this association occurs with both loop and thiazide diuretics in a population based multi-ethnic sample reporting gout incidence.

To cite this abstract, please use the following information:
McAdams, Mara A., Maynard, Janet W., Gelber, Allan C., Baer, Alan N., Coresh, Josef; Thiazide and Loop Diuretics Are Associated with Incident Gout in the Atherosclerosis Risk in Communities (ARIC) Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1569
DOI: 10.1002/art.29335

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