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2013 ; 72
(5
): 701-6
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A urate gene-by-diuretic interaction and gout risk in participants with
hypertension: results from the ARIC study
#MMPMID22753387
McAdams-DeMarco MA
; Maynard JW
; Baer AN
; Kao LW
; Kottgen A
; Coresh J
Ann Rheum Dis
2013[May]; 72
(5
): 701-6
PMID22753387
show ga
OBJECTIVE: To test for a urate gene-by-diuretic interaction on incident gout.
METHODS: The Atherosclerosis Risk in Communities Study is a prospective
population-based cohort of 15 792 participants recruited from four US communities
(1987-1989). Participants with hypertension and available single nucleotide
polymorphism (SNP) genotype data were included. A genetic urate score (GUS) was
created from common urate-associated SNPs for eight genes. Gout incidence was
self-reported. Using logistic regression, the authors estimated the adjusted OR
of incident gout by diuretic use, stratified by GUS median. RESULTS: Of 3524
participants with hypertension, 33% used a diuretic and 3.1% developed gout. The
highest 9-year cumulative incidence of gout was in those with GUS above the
median and taking a thiazide or loop diuretic (6.3%). Compared with no thiazide
or loop diuretic use, their use was associated with an OR of 0.40 (95% CI 0.14 to
1.15) among those with a GUS below the median and 2.13 (95% CI 1.23 to 3.67) for
those with GUS above the median; interaction p=0.006. When investigating the
genes separately, SLC22A11 and SLC2A9 showed a significant interaction,
consistent with the former encoding an organic anion/dicarboxylate exchanger,
which mediates diuretic transport in the kidney. CONCLUSIONS: Participants who
were genetically predisposed to hyperuricaemia were susceptible to developing
gout when taking thiazide or loop diuretics, an effect not evident among those
without a genetic predisposition. These findings argue for a potential benefit of
genotyping individuals with hypertension to assess gout risk, relative in part to
diuretic use.