Risk acceleration by gout on major adverse cardiovascular events and all-cause death in patients with diabetes and chronic kidney disease

Aims: We aimed to examine the impact of gout on cardiovascular disease (CVD) and mortality risk in patients with type 2 diabetes and explore whether chronic kidney disease (CKD) modifies this association.

Materials and methods: Using the Korean National Health Insurance Service database, 757 378 individuals with type 2 diabetes were classified into the CKD^-Gout^-, CKD^-Gout⁺, CKD⁺Gout^-, and CKD⁺Gout⁺ groups. Cox proportional hazard models were used to assess the risk of myocardial infarction (MI), ischemic stroke, and mortality, after adjusting for cardiometabolic factors.

Results: Over a median follow-up of 9.3 years, 25 618, 38 691, and 78 628 individuals experienced MI, stroke, and mortality, respectively. The risk of MI or stroke progressively increased across the groups, with the highest adjusted hazard ratio (HR) in the CKD⁺Gout⁺ group (HR: 1.57, 95% confidence interval [CI]: 1.46-1.69), followed by the CKD⁺Gout^- group (HR: 1.23, 95% CI 1.20-1.26). The CKD⁺Gout⁺ group showed the greatest risks for MI (HR: 1.71), stroke (HR: 1.46), and mortality (HR: 1.78). Individuals with gout alone did not exhibit a significant increase in risk compared with those without gout or CKD. Interaction analyses indicated that the effect of gout on the outcomes was more pronounced in patients with CKD. Subgroup analyses yielded consistent findings across diverse demographic and clinical characteristics.

Conclusions: CKD with or without gout increased the risk of CVD and mortality, with the highest risk observed in the CKD⁺Gout⁺ group. The interaction between CKD and gout significantly influenced these outcomes.