Purpose: Cholesterol screening in young adults is a common preventive strategy to assess risk for preclinical coronary heart disease (CHD). Several factors related to incident CHD, including hypertension and obesity, are similarly related to the development of gout. We sought to identify whether serum cholesterol, measured in early adult life, might predict incident gout in men.
Method: Serum cholesterol was measured at a mean age of 22 years among 1040 male medical students who graduated from 1948-1964 and have since been prospectively followed to detect incident disease. Cumulative incidence was estimated using Kaplan-Meier analysis. In addition, the risk of incident gout associated with the highest quintile of serum cholesterol was estimated using Cox proportional hazards analysis, with adjustment for body mass index at age 35 years and time-dependent hypertension.
Results: At cohort entry, mean cholesterol was 189.7 mg/dl (5.84 mmol/L). During a median follow-up of 45 years, a total of 139 men developed gout. Sixty participants reporting incident gout were mailed the ACR Criteria for the Classification of Gout, among whom 42 returned the questionnaire. Within this group, 34 fulfilled the ACR criteria; the other 8 satisfied criteria based on medical record review. Median age at gout onset was 58 years. Overall, the cumulative incidence of gout was 20%, and greater in the highest compared to the lowest 4 combined cholesterol quintiles (p=0.01). The relative risk of incident gout associated with the highest quintile of serum cholesterol, >209 mg/dl, was as follows:
Model for all Gout Relative Risk 95% confidence interval
Cholesterol, unadjusted 1.7 1.1 – 2.5
Time-dependent hypertension, cholesterol-adjusted 1.9 1.2 – 2.9
Weight at age 35, cholesterol-adjusted 1.1 1.0 – 1.2
Cholesterol, hypertension and weight-adjusted 1.6 1.1 – 2.4
Model for Gout onset prior to 60 years Relative Risk 95% confidence interval
Cholesterol, hypertension- weight-adjusted 2.2 1.3 – 3.7
Conclusion: During greater than four decades of follow-up, approximately 20% of the cohort developed gout. Moreover, the highest quintile of serum cholesterol, >209 mg/dl at a mean age of 22 years, was related to a 60% increase in risk of incident gout. This heightened risk was most apparent for gout that occurred prior to the age of 60 years. These findings imply that measurement of serum cholesterol in young adults, obtained during health maintenance screening to identify risk for CHD, is also of value to identify men at heightened risk to develop gout.
Disclosure: A. C. Gelber, None; L. Meoni, None; A. Chu, None; M. J. Klag, None.