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Postmenopausal Women's Risk of Gout Increases, Like Men's, With Obesity, Hypertension, and Use of Diuretics: Presented at ACR

By Paula Moyer

San Diego, CA -- November 17, 2005 -- Women who have passed menopause are just as likely to acquire gout as are men, according to research presented here at the American College of Rheumatology Annual Scientific Meeting (ACR).

As with men, women with obesity or hypertension, and those who use diuretics have a higher risk of gout. Therefore, physicians should use the same approach to preventing gout flares in women as they do in men, researchers said during a presentation on November 15^th.

"Gout is one of the most painful conditions experienced by human beings," said principal investigator Hyon Choi, MD, DrPH, associate professor of medicine, University of British Columbia, Vancouver, British Columbia, Canada. "Therefore, modifying the risk factors by losing weight and controlling hypertension would not only be beneficial generally, but would reduce considerable morbidity simply by preventing gout."

Although the increasing incidence of gout in women was established in earlier studies, Dr. Choi and his coinvestigators saw the need to conduct a population-based study that assessed the risk factors for gout in women.

Dr. Choi led the study when he was director of outcomes research at Massachusetts General Hospital, Boston, Massachusetts.

Obesity, hypertension, and diuretic use are all known to be strong independent risk factors for gout in men, so Dr. Choi and his colleagues conducted a study to see if women would have the same risk factors.

The researchers used data from the Nurses' Health Study and followed 92,224 women who had no history of gout at baseline.

From 1980 to 2004, the participants responded to questionnaires every 2 years that queried them about their weight, body mass index (BMI), 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 also responded to food-frequency questionnaires that asked about their dietary and alcohol intake.

Participants also responded to a mailed questionnaire, which the investigators used to ascertain whether a participant had gout as defined by ACR criteria.

The data were analyzed and the researchers made adjustments for age, total energy intake, BMI, hypertension, 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. Among these data, the investigators identified 444 confirmed incident cases of gout. At baseline, the women were an average of 46 years old and had a BMI of 24 kg/m².

Meat consumption averaged 1.7 servings daily, and total seafood consumption consisted of 0.2 servings daily. They also consumed 1.9 dairy servings daily and an average of 6 g of alcohol daily. Animal proteins comprised 16% of total caloric energy.

Six percent of the women had hypertension and 10% used diuretics.

Among women with a BMI of less than 23 kg/m², there were 43 cases for 598,506 person-years.

Women with BMI between 23 and 24.9 kg/m² had a 1.55 relative risk (RR) of gout (multivariate-adjusted). The risk continued to increase with increasing BMI, so that it was 2.86 for those with a BMI of 25 to 29.9 kg/m², 4.69 for a BMI of 30 to 34.9 kg/m², and 7.25 for BMI exceeding 35 kg/m² (P < .001 for trend).

Hypertension was associated with a 2.26 relative risk, and the use of diuretics had a relative risk of 2.63.

"These results are closely in line with the data observed among men," the study's authors concluded. "The growing 'epidemics' of obesity and the increasing prevalence of hypertension and diuretic use present a substantial challenge in the prevention and management of gout."


[Presentation Title: Adiposity, Hypertension, Diuretic Use and Risk of Incident Gout in Women - The Nurses Health Study. Abstract 1977]

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