Gout and the risk for incident heart failure and systolic dysfunction

OBJECTIVE To test the hypothesis that gouty arthritis (gout) is a risk factor for incidence of heart failure and for echocardiographic measures signifying subclinical heart failure. DESIGN Post-hoc, longitudinal and cross-sectional analyses of a prospective cohort study where data were collected in 4-year intervals since 1971. SETTINGS The population-based Framingham Offspring Study. PARTICIPANTS 4989 adults (mean age 36 years, 52% women) free of clinical heart failure at baseline. OUTCOME MEASURES Incident heart failure, echocardiographic measures of left ventricular systolic dysfunction, dilatation and hypertrophy. RESULTS Participants with gout (n=228) had two to three times higher incidence of clinical heart failure and echocardiographic measures of systolic dysfunction compared with those without. In Cox regression analyses, gout was associated with an adjusted HR of 1.74 (95% CI 1.03 to 2.93) for incident heart failure and RRs of 3.70 (95% CI 1.68 to 8.16) for abnormally low left ventricular ejection fraction and of 3.60 (95% CI 1.80 to 7.72) for global left ventricle systolic dysfunction. These risk relationships were consistently observed in all clinical subgroups. Overall, participants with gout had greater mortality than those without (adjusted HR 1.58, 95% CI 1.40 to 1.78). Mortality was elevated in subgroup of patients with gout and heart failure (adjusted HR 1.50, 95% CI 1.30 to 1.73) compared to those with heart failure but without gout. CONCLUSION Gout is associated with increased risk for clinical heart failure, subclinical measures of systolic dysfunction and mortality.