Incident Gout and Risk of First‐Time Acute Coronary Syndrome: A Prospective, Population‐Based Cohort Study in Sweden

Objective To investigate the risk of first‐time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout compared to the general population. Methods Using register data for the period 2007–2017, we conducted a prospective, population‐based cohort with 20,146 patients with incident gout (mean age 65.6 years; 67.4% male) and 83,517 matched population controls without prior history of coronary heart disease. We calculated incidence rates (IRs) and hazard ratios (HRs) adjusted for baseline comorbidities and dispensed prescriptions. In a sensitivity analysis, we included gout cases and controls with no previously diagnosed comorbidity (6,075 cases and 44,091 controls). Results The IR of first‐time ACS was significantly increased in the gout cohort compared to controls (9.1 versus 6.3 of 1,000 person‐years). Unadjusted Cox regression showed that gout patients had higher risk of first‐time ACS compared to controls (HR 1.44 [95% confidence interval (95% CI) 1.33–1.56]), with a higher HR in women (HR 1.64 [95% CI 1.41–1.90]) than in men (HR 1.36 [95% CI, 1.24–1.50]). In multivariable analysis, the risk diminished but remained significant (HR 1.15 [95% CI 1.06–1.25]). The risk was similar in the sensitivity analysis (HR 1.20 [95% CI 1.01–1.44]) and still higher in women (HR 1.34 [95% CI 0.86–2.08]) than in men (HR 1.18 [95% CI 0.97–1.44]). Conclusion Patients with incident gout have a 44% increased risk of first‐time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, but there is still a modestly increased risk that may be due to gout‐related factors.