Background: There are limited data available on the association of gouty arthritis (gout) in middle age with longterm cardiovascular disease (CVD) mortality. Methods: We performed a 17-year follow-up study of 9105 men, aged 41 to 63 years and at above-average risk for coronary heart disease, who were randomized to the Multiple Risk Factor Intervention Trial and who did not die or have clinical or electrocardiographic evidence of coronary artery disease during the 6-year trial. Risk of CVD death and other causes subsequent to the sixth annual examination associated with gout was assessed by means of Cox proportional hazards regressions. Results: The unadjusted mortality rates from CVD among those with and without gout were 10.3 per 1000 personyears and 8.0 per 1000 person-years, respectively, representing an approximately 30% greater risk. After adjustment for traditional risk factors, use of diuretics and aspirin, and serum creatinine level, the hazard ratio (gout vs no gout) for coronary heart disease mortality was 1.35 (95% confidence interval [CI], 1.06-1.72). The hazard ratio for death from myocardial infarction was 1.35 (95% CI, 0.94-1.93); for death from CVD overall, 1.21 (95% CI, 0.99-1.49); and for death from any cause, 1.09 (95% CI, 1.00-1.19) (P=.04). The association between hyperuricemia and CVD was weak and did not persist when analysis was limited to men with hyperuricemia without a diagnosis of gout. Conclusion: Among middle-aged men, a diagnosis of gout accompanied by an elevated uric acid level imparts significant independent CVD mortality risk.

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The incidence of ESRD is increasing rapidly. Limited information exists regarding early markers for the development of ESRD. This study aimed to determine over 25 yr the risk for ESRD associated with proteinuria, estimated GFR (eGFR), and hematocrit in men who did not have identified kidney disease and were randomly assigned into the Multiple Risk Factor Intervention Study (MRFIT). A total of 12,866 men who were at high risk for heart disease were enrolled (1973 to 1975) and followed through 1999. Renal replacement therapy was ascertained by matching identifiers with the United States Renal Data System's data; vital status was from the National Death Index. Men who initiated renal replacement therapy or died as a result of kidney disease were deemed to have developed ESRD. Dipstick urine for proteinuria, eGFR, and hematocrit were related to development of ESRD. T he incidence of ESRD has increased rapidly in the past decade, and the number of people with ESRD is projected to double by the year 2010 (1). Despite this rapid increase, limited information exists regarding early markers for the development of ESRD. Previous groups have studied either individuals with established chronic kidney disease (CKD) or unknown baseline kidney function. Most studies of individuals with established kidney disease have had short durations of follow-up and used surrogate markers for ESRD, such as change in GFR or doubling of serum creatinine in addition to ESRD as end points (2-6). Whether these markers are useful in identifying individuals who are at high risk for developing ESRD over the long term is uncertain. Other studies, including investigations of the cohort of men who were screened for the Multiple Risk Factor Intervention Trial (MRFIT), have followed individuals for a long time (7-13). These studies established BP, diabetes, and black race as major risk factors for ESRD, but they did not include assessment of renal function at baseline. Recognizing the limitations of previous studies, we aimed to determine over 25 yr the risk for ESRD associated with casual dipstick proteinuria, estimated GFR (eGFR), and hematocrit in individuals who did not have identified kidney disease at baseline and were randomly assigned in the MRFIT study. Materials and MethodsMRFIT was a multicenter, randomized trial to study the effect of an intervention program that was designed to lower BP, to decrease serum cholesterol by dietary changes and to achieve smoking cessation in men who were at high risk for cardiovascular disease (CVD). Details concerning the screening have been published (14 -16). Briefly, between