Obesity and Hypertension Equalize Women's Risk of Gout after Menopause

Paula Moyer, MA

November 17, 2005

Nov. 17, 2005 (San Diego) — Postmenopausal women have as great a chance of developing gout as do men, according to a team of investigators who presented their findings here at the annual scientific meeting of the American College of Rheumatology (ACR).

After menopause, women who are obese, who have hypertension, or who are treated with diuretics have an increased risk of gout comparable to that for men, the investigators reported. Therefore, the same approach that is used to prevent gout flares in men would be useful in women with gout, they reported.

"The same treatment strategies for reducing these risk factors in men should be applicable to women," said principal investigator Hyon Choi, MD, DrPH. "Because gout is one of the most painful conditions experienced by human beings, modifying the risk factors for gout would not only be beneficial generally but would reduce considerable morbidity by reducing the risk of gout alone." Dr. Choi is an associate professor of medicine at the University of British Columbia in Vancouver, Canada. He spearheaded the study when he was the director of outcomes research at Massachusetts General Hospital in Boston.

Although gout has been increasing in incidence among women, Dr. Choi and colleagues wanted to address the need for a population-based study that assessed risk factors for incident gout in women. Because obesity, hypertension, and diuretic use were all found to be strong independent risk factors for gout in men, they wanted to know if these would also be risk factors in women. They used data from the Nurses' Health Study and followed a cohort of 92,224 women who had no history of gout at baseline.

Beginning in 1980, the participants responded to questionnaires every two years that queried them regarding their weight, body mass index (BMI), the existence of physician-diagnosed medical conditions, and regular use of medications. The diagnosis of hypertension and the use of diuretics were included among the conditions and medications listed in the questionnaire. The participants responded to food-frequency questionnaires that asked about their dietary and alcohol intake.

The participants also responded to a mailed questionnaire, which the investigators used to ascertain whether a participant had gout as defined by ACR criteria. The investigators then analyzed the data and made adjustments for age, total energy intake, BMI, hypertension, the use of medication such as diuretics and hormone replacement therapy, and dietary intake, including alcohol, total meats, dairy products, and seafood.

The 24 years of follow-up involved 2,073,979 person-years. The investigators identified 444 confirmed incident cases of gout. At baseline, the women with gout were an average age of 46 years and had a BMI of 24 kg/m 2. Their total meat consumption averaged 1.7 servings daily, and their total seafood consumption consisted of 0.2 servings daily. They also consumed 1.9 dairy servings daily and an average of 6 g daily of alcohol. Animal protein made up 16% of their total caloric energy. At that time 6% of the women had hypertension and 10% used diuretics.

Of the women with a BMI less than 23 kg/m 2, there were 43 cases of gout for 598,506 person-years. Of the women whose BMI was 23.0 to 24.9 kg/m 2, the multivariate-adjusted relative risk for gout was 1.55. The risk continued to rise so that it was 2.86 for those with a BMI of 25.0 to 29.9 kg/m 2, 4.69 for a BMI of 30.0 to 34.9 kg/m 2, and 7.25 for those whose BMI exceeded 35 kg/m 2 ( P < .001 for trend). Hypertension was associated with a 2.26 relative risk for gout, and the use of diuretics had a relative risk of 2.63.

"This is the first prospective study of risk factors for gout in women," said Elizabeth W. Karlson, MD, in an interview seeking independent comment. Dr. Karlson is an associate professor of medicine at Harvard Medical School in Boston, Massachusetts, where she is an attending rheumatologist at Brigham and Women's Hospital.

"The most striking thing about the study is the BMI relationship," she said. "Typical epidemiologic studies show risk factors of 1.5 to 3.0. In this study, there is a relative risk of 4.7 for obese women acquiring gout and the relative risk is 7.3 for morbidly obese women."

The findings reinforce the literature showing numerous adverse health outcomes associated with obesity, Dr. Karlson said. "It's important to counsel women to lose weight and reduce the risk of gout. It's also important to treat hypertension to prevent gout, but when we do, we need to use medications other than diuretics, and there certainly are other choices."

ACR 2005 Annual Scientific Meeting: Abstract 1977. Presented Nov. 15, 2005.

Reviewed by Helen Fosam, PhD

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