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Objective To determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension.Design Nested case-control study.Setting UK general practice database, 2000-7.Participants All incident cases of gout (n=24 768) among adults aged 20-79 and a random sample of 50 000 matched controls.Main outcome measure Relative risk of incident gout associated with use of antihypertensive drugs.Results After adjusting for age, sex, body mass index, visits to the general practitioner, alcohol intake, and pertinent drugs and comorbidities, the multivariate relative risks of incident gout associated with current use of antihypertensive drugs among those with hypertension (n=29 138) were 0.87 (95% confidence interval 0.82 to 0.93) for calcium channel blockers, 0.81 (0.70 to 0.94) for losartan, 2.36 (2.21 to 2.52) for diuretics, 1.48 (1.40 to 1.57) for β blockers, 1.24 (1.17 to 1.32) for angiotensin converting enzyme inhibitors, and 1.29 (1.16 to 1.43) for non-losartan angiotensin II receptor blockers. Similar results were obtained among those without hypertension. The multivariate relative risks for the duration of use of calcium channel blockers among those with hypertension were 1.02 for less than one year, 0.88 for 1-1.9 years, and 0.75 for two or more years and for use of losartan they were 0.98, 0.87, and 0.71, respectively (both P<0.05 for trend).Conclusions Compatible with their urate lowering properties, calcium channel blockers and losartan are associated with a lower risk of incident gout among people with hypertension. By contrast, diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout.

The excess risk of mortality in individuals with vs without diabetes has decreased over time in both Canada and the UK. This may be in part due to earlier detection and higher prevalence of early diabetes, as well as to improvements in diabetes care.

This study provides Class III evidence that discontinuation of low-dose ASA is associated with a 40% increased risk of stroke within 31-180 days of discontinuation.

This population-based study indicates an increased risk of PE and DVT in RA, supporting increased monitoring of venous-thromboembolic complications and risk factors in RA, regardless of hospitalisation.

Objectives To evaluate the risk of myocardial infarction and death from coronary heart disease after discontinuation of low dose aspirin in primary care patients with a history of cardiovascular events.

IntroductionThe objective of this study was to investigate the contemporary incidence of gout, examine potential risk factors, and evaluate specific gout treatment patterns in the general population.MethodsUsing the health improvement network (THIN) UK primary care database, we estimated the incidence of gout based on 24,768 newly diagnosed gout patients among a cohort of 1,775,505 individuals aged 20 to 89 years between 2000 and 2007. We evaluated potential risk factors for incident gout in a nested case-control study with 50,000 controls frequency-matched by age, sex and calendar time. We calculated odds ratios (OR) by means of unconditional logistic regression adjusting for demographic variables, lifestyle variables, relevant medical conditions and drug exposures.ResultsThe incidence of gout per 1,000 person-years was 2.68 (4.42 in men and 1.32 in women) and increased with age. Conventional risk factors were significantly and strongly associated with the risk of gout, with multivariate ORs of 3.00 (95% confidence interval (CI)) for excessive alcohol intake (that is, more than 42 units per week), 2.34 (95% CI 2.22 to 2.47) for obesity (body mass index > = 30 kg/m2), 2.48 (95% CI 2.19 to 2.81) for chronic renal impairment, and 3.00 (95% CI 2.85 to 3.15) for current diuretic use. For other medical conditions the multivariate OR were 1.84 (95% CI 1.70 to 2.00) for heart failure, 1.45 (95% CI 1.18 to 1.79) for hypertriglyceridemia and 1.12 (95% CI 1.04 to 1.22) for psoriasis. Use of cyclosporine was associated with an OR of 3.72 (95% CI, 2.17 to 6.40). Among gout-specific therapies, allopurinol was the most frequently used with a one-year cumulative incidence of 28% in a cohort of incident gout diagnosed from 2000 to 2001. Use of gout-specific treatment has not changed over recent years except for an increase of colchicine.ConclusionsThe contemporary incidence of gout in UK remains substantial. In this general population cohort, associations with previously purported risk factors were evident including psoriasis, heart failure, hypertriglyceridemia, and cyclosporine therapy. Use of gout-specific treatment has remained relatively constant in recent years except for an increase of colchicine.

OBJECTIVE Although type-2 diabetes is considered a comorbid condition of gout, the uricosuric effect of glycosuria or the impaired inflammatory response in diabetes may actually reduce the future risk of gout. We evaluated the impact of diabetes on the future risk of developing gout. METHODS We conducted a case-control study nested in a UK general practice database (the Health Improvement Network) by identifying all incident cases of gout (N=24,768) and randomly sampled 50,000 controls who were 20–79 years between 2000 and 2007. We examined the independent effect of type-1 and type-2 diabetes on the development of incident gout. RESULTS After adjusting for age, sex, body mass index, general practitioner visits, smoking, alcohol intake, ischemic heart disease, and presence of cardiovascular risk factors, the relative risk (RR) for incident gout among diabetes patients, as compared with individuals with no diabetes was 0.67 (95% CI, 0.63 to 0.71). The multivariate RRs with the duration of diabetes of 0–3, 4–9, and ≥ 10 years were 0.81 (95% CI, 0.74 to 0.90), 0.67 (95% CI, 0.61 to 0.73), and 0.52 (95% CI, 0.46 to 0.58), respectively. The inverse association was stronger with type 1 diabetes than with type 2 diabetes (multivariate RR, 0.33 vs. 0.69; P value < 0.001). The inverse association was stronger among men than women (multivariate RR [95% CI], 0.59 [0.53 to 0.64] vs. 0.90 [0.80 to 1.00]; P value for interaction <0.001). CONCLUSIONS Individuals with diabetes are at a lower future risk of gout independent of other risk factors. These data provide support for a substantial role of the pathophysiology associated with diabetes (e.g. the uricosuric effect of glycosuria and the impaired inflammatory response) against the risk of developing gout.