Wednesday, 20 Mar 2019

You are here

Sleep Apnea Increases Gout Risk

Both Gout and obstructive sleep apnea (OSA) comingle with a wide range of serious comorbidities. A matched retrospective cohort study from the UK Clinical Practice Research database shows those with OSA are at a higher risk of developing gout.

This report compared 15,879 patients with OSA versus 63,296 without; median follow‐up was 5.8 years.

Roughly 5% of OSA patients developed incident gout; half that many (2.6%) for those without OSA. The adjusted HR was 1.42 (95% CI 1.29–1.56).

For those who were overweight and obese, the risk of gout was highest 1–2 years after the index OSA date (HR 1.64).  For those with normal BMI, the highest significant HR (2.02) was at 2–5 years after the index date.

The converse association has also been shown by Singh and Cleveland. (Citation source: https://buff.ly/2BX2zvJ).

A Medicare population-based study found a two-fold increase risk of OSA in gout patients.  Based on a 5% sample of elderly patients they found higher rates of OSA in gout patients (14.3 per 1,000 person-years) versus 3.9 per 1,000 person-years in people without gout (HR 2.07; 95% confidence interval 2.00, 2.15).

The question is: does OSA lead to gout or does gout lead to OSA? Or, do the comorbidities of each (obesity, CAD, HTN, metabolic syndrome) augment the odds of either gout and OSA, especially in an aging population.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Ironwood Retreats from the US Gout Market

Ironwood Pharmaceuticals discontinued the marketing and sales of both lesinurad (Zurampic) the combination drug of lesinurad and allopurinol (Duzallo) in the United States effective February 1, 2019. In addition the Duzallo and Zurampic Patient Savings Program were also discontinued on December 31, 2018.

The company stated that this was a financial decision unrelated to the efficacy or safety of lesinurad.

Allopurinol Reduces Cardiovascular Outcomes in Diabetes

A Canadian study has shown that elderly diabetics who take allopurinol have a significant reduction in cardiovascular outcomes.  

Hyperuricemia has been shown to be a biomarker for cardiovascular outcomes in multiple disorders. These investigators studied the effect of allopurinol and mortality on CV outcomes in a population-based retrospective cohort study from Ontario, Canada.

FDA Slaps a Boxed Warning on Febuxostat for CV Risk

The U.S. Food and Drug Administration (FDA) has reviewed data from the Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial and concluded there is an increased risk of death with Uloric (febuxostat) compared with allopurinol, and has added this as a boxed warning to the drug’s product label.

U.S. Gout Rates Remain Steady, but Substantial

Using data from 5,467 adults in the US in the National Health and Nutrition Examination Survey (NHANES) for the years 2007-2016, researchers found that the prevalence of gout and hyperuricemia has remained at 3.9%, having doubled from the 1960s to the 1990s, corresponding to an estimated 9.2 million adults with gout in 2015-2016.

Febuxostat Gets Reprieve from FDA Advisory Panel

On January 11, 2019 the FDA convened two advisory panels (the Arthritis Advisory Committee [AAC] and the Drug Safety and Risk Management Advisory Committee [DSaRM]) to consider the cardiovascular safety of febuxostat (Uloric) based on the 2018 “Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) study. 

The Vote