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Higher Risk of AMI in Women With Gout

  • Authors: News Author: Shelley Wood
    CME Author: Désirée Lie, MD, MSEd
  • CME Released: 2/17/2010
  • Valid for credit through: 2/17/2011, 11:59 PM EST
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Target Audience and Goal Statement

This article is intended for primary care clinicians, geriatricians, rheumatologists, endocrinologists, cardiologists, and other specialists who care for older women with gout.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe the association between gout and the risk for acute myocardial infarction in older women.
  2. Compare the risk for acute myocardial infarction associated with gout between men and women.


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  • Shelley Wood

    Shelley Wood is a journalist for, part of the WebMD Professional Network. She has been with since 2000, and specializes in interventional cardiology. She studied literature at McGill University and the University of Cape Town and received her graduate degree in journalism from the University of British Columbia, specializing in health reporting. She can be reached at [email protected].


    Disclosure: Shelley Wood has disclosed no relevant financial relationships.


  • Brande Nicole Martin

    CME Clinical Editor, Medscape, LLC


    Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
    Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

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  • Sarah Fleischman

    CME Program Manager, Medscape, LLC


    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Higher Risk of AMI in Women With Gout

Authors: News Author: Shelley Wood CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME Released: 2/17/2010

Valid for credit through: 2/17/2011, 11:59 PM EST


February 17, 2010 — A new population-based cohort study has found that women with gout but no history of ischemic heart disease had a 40% increased risk of acute myocardial infarction (AMI) over a seven-year follow-up period, compared with matched controls with no gout [1]. Authors of the study say their paper fills a knowledge gap linking gout and AMI in women; previous studies have focused on the independent impact of gout in men.

In fact, write Dr Mary A De Vera (Boston University School of Medicine, MA) and colleagues, the magnitude of risk associated with gout may actually be higher in women than in men. Speaking with heartwire , senior author on the study, Dr Hyon K Choi (Boston University School of Medicine), explained that the paper is the first to suggest that gout is an independent risk factor for coronary heart disease in women, as it has previously been shown to be in men. "This extends what we found in males and in fact seems more dramatic, more strongly associated with heart disease."

Their study appears online February 2, 2010 in the Annals of the Rheumatic Diseases.

De Vera et al reviewed incident rates of AMI in the British Columbia Linked Health Database, comparing rates between 9642 gout cases and 48 210 controls. Despite having no history of ischemic heart disease, 3268 subjects (996 women) experienced AMI over a median seven-year follow-up. Relative risk of both fatal and nonfatal MI was higher among men and women with gout than among those with no gout, particularly in women. That difference persisted even after adjustment for age, comorbidities, and prescription drug use.

Adjusted Relative Risk (99% CI) of AMI Among Men and Women With Gout

Outcome Women Men
Nonfatal AMI 1.41 (1.19–1.67) 1.11 (0.98–1.25)
Fatal AMI 1.33 (0.99–1.78) 1.10 (0.88–1.38)
All AMI 1.39 (1.20–1.61) 1.11 (0.99–1.23)

The authors point out that the increase in adjusted relative risk of AMI among women compared with men was statistically significant, a pattern also seen for nonfatal AMI (but not for fatal MI).

Gout develops from elevated levels of uric acid, which crystallizes in joints and surrounding tissue. The link between gout and coronary disease may relate to effects of hyperuricemia on vascular smooth-muscle-cell proliferation and inflammation, as well as platelet adhesiveness and aggregation, the authors note. As to why gout's relationship to AMI might be more powerful in women than in men, De Vera and colleagues point out that serum uric-acid levels are typically higher in men but start climbing in women around menopause. As Choi explained, even though the absolute level of uric acid in men and women might be similar, the "relative worsening" in women is typically greater, and this may have a more powerful physiological disruption on women than on men.

"These findings provide support for the aggressive management of cardiovascular risk factors for male and female patients with gout," the authors conclude.

To heartwire , Choi observed that cardiologists may already be thinking of gout as a heart disease risk factor in men; they should now do the same for female patients. He also emphasized that while the manifestation of gout is major joint discomfort and disability, it is fundamentally an inflammatory/metabolic condition, like diabetes. As such, "it's not surprising" that this would have cardiovascular effects. "That part is less well acknowledged by physicians," he noted.


  1. De Vera MA, Rahman MM, Bhole V, et al. Independent impact of gout on the risk of acute myocardial infarction among elderly women: a population-based study. Ann Rheum Dis 2010; DOI:10.1136/ard.2009.1227701. Available at:

Clinical Context

Gout affects up to 9% and 6% of elderly men and women, respectively. In men, gout has been linked with a higher risk for coronary artery disease, but the risk has not been well studied in women. The mechanism may be related to hyperuricemia affecting smooth muscle proliferation and the inflammation associated with gout.

This is a prospective, population-based cohort study conducted in 1 province of Canada to examine the association between gout and the risk for AMI in elderly women.

Study Highlights

  • The British Columbia Linked Health Database was used to identify patients with gout.
  • The database covers the entire province of 4.3 million and provides longitudinal data on healthcare visits, hospitalizations, and prescriptions.
  • The British Columbia Musculoskeletal Cohort covered 3.5 million persons with any musculoskeletal problem between 1991 and 2004, with 9642 subjects (3890 women) and 48,210 control subjects matched by age, sex, date of diagnosis (index date), and length of medical record.
  • For this study, subjects were included if they had no ischemic heart disease at baseline.
  • Gout was identified with use of International Classification of Diseases, Ninth Revision, codes in patients older than 65 years.
  • AMI was identified from hospital data using International Classification of Diseases, Ninth Revision, codes.
  • Subjects were observed from baseline to AMI; deregistration from medical plan; and death or end of the study (2005), whichever came first.
  • Analysis of the risk for AMI was performed for women and men in the cohort and was compared vs control subjects without gout.
  • For women, the mean age was 75 years; for men, 73 years.
  • Women with gout had a higher rate of hypertension (65.6% vs 47.4%), chronic obstructive airway disease (25.6% vs 19.6%), diabetes (18.5% vs 11.3%), and hyperlipidemia (14.7% vs 11.0%) vs women without gout.
  • At a median of 7 years of follow-up, there were 3268 incident AMI cases, 996 among women.
  • In women with gout, after adjustment for age, comorbidities, and prescriptions, the relative risk for all fatal AMI was 1.39, and the relative risk for nonfatal AMI was 1.41 vs control subjects without gout.
  • For men, the relative risk was 1.11 for all AMI and nonfatal AMI.
  • The risk for AMI was higher in women vs men for all AMI and for nonfatal AMI (P = .003 and P = .005, respectively, for sex comparison).
  • A significant difference in sex risk was seen for nonfatal, but not fatal, AMIs.
  • The authors concluded that gout in women was associated with an increased risk for AMI higher than that seen in men, and the difference between sexes was significant for nonfatal AMI events.
  • They suggested that male and female patients with gout be aggressively treated for cardiovascular risk.

Clinical Implications

  • Older women with gout have an increased risk for AMI vs women without gout.
  • The risk for nonfatal AMI associated with gout is higher in women vs men.

CME Test

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