Altered Risk of Incident Gout According to Changes in Metabolic Syndrome Status: A Nationwide, Population‐Based Cohort Study of 1.29 Million Young Men

Abstract

Objective. Few data are available on whether changes in metabolic syndrome affect incident gout. This study was undertaken to assess associations between metabolic syndrome status and incident gout, as well as changes in the clinical characteristics of metabolic syndrome and incident gout, in a cohort of young men.Methods. This nationwide, population-based cohort study included 20-39-year-old men who participated in serial health check-ups. The outcome, incident gout, was defined according to the claims database diagnostic code for gout. Associations among changes in metabolic syndrome status and incident gout were analyzed using Cox proportional hazards models.Results. Among 1,293,166 individuals, 18,473 were diagnosed as having gout (incidence rate 3.36 per 1,000 personyears). Subjects who had chronic metabolic syndrome (defined as metabolic syndrome at all 3 health check-ups) had a nearly 4-fold higher risk of incident gout compared to subjects who did not have metabolic syndrome at any of the 3 health check-ups (adjusted hazard ratio [HR adj ] 3.82 [95% confidence interval (95% CI) 3.67-3.98]). Development of metabolic syndrome more than doubled the risk of incident gout (HR adj 2.31 [95% CI 2.20-2.43]). Conversely, recovery from metabolic syndrome reduced the risk of incident gout by nearly half (HR adj 0.52 [95% CI 0.49-0.56]). Among metabolic syndrome components, changes in elevated triglycerides (development of elevated triglycerides, HR adj 1.74 [95% CI 1.66-1.81]; recovery from elevated triglycerides, HR adj 0.56 [95% CI 0.54-0.59]) and abdominal obesity (development of abdominal obesity, HR adj 1.94 [95% CI 1.85-2.03]; recovery from abdominal obesity, HR adj 0.69 [95% CI 0.64-0.74]) showed the greatest association with altered risk of incident gout. Associations between changes in the status and clinical characteristics of metabolic syndrome and incident gout were more pronounced in subjects ages 20-29 years compared to those ages 30-39 years, and in subjects who were underweight or who had a normal weight.Conclusion. Changes in the status and clinical characteristics of metabolic syndrome were associated with altered risk of incident gout. These results suggest that metabolic syndrome is a modifiable risk factor for gout.

Women with Metabolic Syndrome and Unhealthy Lifestyle Factors Are at a Higher Risk for Hyperuricemia

“…Although this result does not imply causality, careful monitoring and management may be necessary for the prevention of HUA in women smokers with MetS. Considering previous results that indicate a 50% reduction in the risk of developing gout when recovering from MetS, treating MetS could serve as secondary prevention for HUA [48]. In a UK biobank study, it was confirmed that adopting a healthy lifestyle can reduce the risk of gout associated with genetic factors by almost one-third.…”

The Evolving Landscape of Gout in the Female: A Narrative Review

“…However, T2DM itself was not a causal factor of incident gout in two MR studies [130,131], though there is evidence by MR for a causal role of insulin resistance for hyperuricemia and gout [132]. Metabolic factors related with T2DM such as hyperinsulinemia, obesity, hypertriglyceridemia are strongly linked to hyperuricemia and gout [133,134]. Indeed, hyperinsulinemia was reported to reduce renal fractional excretion of urate via uncharacterized mechanisms [135].…”

The Evolving Landscape of Gout in the Female: A Narrative Review

“…However, T2DM itself was not a causal factor of incident gout in two MR studies [124,126], though there is evidence by MR for a causal role of insulin resistance in hyperuricemia and gout [127]. Metabolic factors related with T2DM, such as hyperinsulinemia, obesity, and hypertriglyceridemia, are strongly linked to hyperuricemia and gout [128,129]. Indeed, hyperinsulinemia was reported to reduce renal fractional excretion of urate via uncharacterized mechanisms [130].…”