Diuretico Y Gota

ARTHRITIS & RHEUMATISM
Vol. 64, No. 1, January 2012, pp 121–129
DOI 10.1002/art.33315
© 2012, American College of Rheumatology

Diuretic Use, Increased Serum Urate Levels, and
Risk of Incident Gout in a Population-Based
Study of Adults With Hypertension
The Atherosclerosis Risk in Communities Cohort Study
Mara A. McAdams DeMarco,1 Janet W. Maynard,2 Alan N. Baer,2 Allan C. Gelber,3
J.Hunter Young,3 Alvaro Alonso,4 and Josef Coresh3
Objective. To quantify the role of diuretic use in
gout development in an adult population with hypertension.
Methods. The Atherosclerosis Risk in Communities study, a prospective population-based cohort from 4
US communities, consisted of 4 visits over a 9-year
period. Participants were included in this analysis if
they answered a query aboutgout, were free of gout at
baseline, and had hypertension (defined as taking medication to treat hypertension or having blood pressure of
>140/90 mm Hg). Trained interviewers recorded use of

antihypertensive drugs. Incident gout was defined as
self-reported onset of gout after baseline. Using a timedependent Cox proportional hazards model, we estimated hazard ratios (HRs; with 95% confidenceintervals [95% CIs]) for incident gout by time-varying
diuretic use, both adjusted for confounders and tested
for mediation by serum urate level.
Results. There were 5,789 participants with hypertension; 37% were treated with a diuretic. Use of any
diuretic (HR 1.48 [95% CI 1.11, 1.98]), a thiazide
diuretic (HR 1.44 [95% CI 1.00, 2.10]), or a loop diuretic
(HR 2.31 [95% CI 1.36, 3.91]) wasassociated with
incident gout as compared with not using any diuretic,
not using a thiazide diuretic, or not using a loop
diuretic, respectively. After adjusting for serum urate
level, the association between diuretic use and gout was
null. Use of antihypertensive medication other than
diuretic agents was associated with decreased gout risk
(adjusted HR 0.64 [95% CI 0.49, 0.86]) compared tountreated hypertension. The longitudinal change in
serum urate levels was 0.72 mg/dl (95% CI 0.57, 0.87)
higher in those who began treatment with a diuretic
than in those who did not (P < 0.001).
Conclusion. Thiazide and loop diuretics were
associated with increased gout risk, an association
mediated by a change in serum urate levels.

Presented in part at the 74th Annual ScientificMeeting of the
American College of Rheumatology, Atlanta, GA, November 2010.
The Atherosclerosis Risk in Communities study is a collaborative study supported by the NIH (National Heart, Lung, and Blood
Institute contracts HHSN-268201100005C, HHSN-268201100006C,
HHSN-268201100007C,
HHSN-268201100008C,
HHSN268201100009C, HHSN-268201100010C, HHSN-268201100011C, and
HHSN-268201100012C). Dr. McAdamsDeMarco’s work was supported by the NIH (National Heart, Lung, and Blood Institute T32
training grant 5-T32-HL-007024). Drs. Maynard, Baer, and Gelber’s
work was supported by the Donald B. and Dorothy Stabler Foundation. Dr. Gelber received additional support from the Ira T. Fine
Discovery Fund.
1
Mara A. McAdams DeMarco, MS, PhD: Johns Hopkins
University Bloomberg School of Public Health,Baltimore, Maryland;
2
Janet W. Maynard, MD, MHS, Alan N. Baer, MD: Johns Hopkins
University School of Medicine, Baltimore, Maryland; 3Allan C. Gelber, MD, MPH, PhD, J. Hunter Young, MD, MHS, Josef Coresh, MD,
PhD: Johns Hopkins University Bloomberg School of Public Health
and Johns Hopkins University School of Medicine, Baltimore, Maryland; 4Alvaro Alonso, MD, PhD: University of MinnesotaSchool of
Public Health, Minneapolis.
Address correspondence to Mara A. McAdams DeMarco,
MS, PhD, Johns Hopkins University, Bloomberg School of Public
Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD
21287. E-mail: mmcadams@jhsph.edu.
Submitted for publication April 7, 2011; accepted in revised
form August 25, 2011.

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