Abstract
Background
Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout
compared with individuals without aortic valve disease.
Methods
This retrospective study evaluated consecutive adults age ≥65 years with aortic stenosis
between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms
(TTEs) separated by at least 1 year. Severe aortic stenosis was defined as any combination
of an aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, aortic valve
area ≤1 cm2, or decrease in left ventricular ejection fraction as a result of aortic stenosis.
Results
Of the 699 study patients, gout was present in 73 patients (10%) and not found in
626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout
and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe aortic stenosis on follow-up transthoracic echocardiogram
was more frequent in patients with gout compared to those without gout (74% vs 54%,
P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without
severe aortic stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development
of severe aortic stenosis after multivariable adjustment (adjusted hazard ratio [aHR]
1.46 [1.03-2.08], P = 0.03). The annualized reduction in aortic valve area was numerically greater in
the group with gout compared with the group without gout (−0.10 cm2/y [−0.18, −0.03] vs −0.08 cm2/y [−0.16, −0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between
groups.
Conclusions
Progression to severe aortic stenosis was more frequent in patients with gout compared
with those without gout, supporting the hypothesis that gout is a risk factor for
aortic stenosis.
Keywords
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Article info
Publication history
Published online: February 18, 2020
Footnotes
Funding: BS was supported in part by the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development (iK2CX001074). NRS was supported in part by an NYU CTSA grant, UL1 TR001445 and KL2 TR001446, from the National Center for Advancing Translational Sciences, National Institutes of Health.
Conflicts of Interest: MHP has received investigator-initiated grants from Hikma Pharmaceuticals and Horizon Therapeutics and serves as a consultant for Sobi, Horizon, and Ampel Biosciences. AA, ACS, CTT, JDL, NRS, VCP, RD report none.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
Published by Elsevier Inc.
