Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008

PurposeThe objective of this study was to estimate the latest prevalence of major comorbidities associated with gout and hyperuricemia in the US based on a recent, nationally representative sample of US men and women.MethodsUsing data from 5707 participants aged 20 years and older in the National Health and Nutrition Examination Survey 2007-2008, we calculated the national prevalence and population estimates of major comorbidities according to gout status and various hyperuricemia levels, compared with those without these conditions. Case definitions of gout and comorbidities were based on an affirmative answer to a question that asked whether a physician or a health professional had diagnosed the corresponding condition.ResultsAmong these individuals with gout, 74% (6.1 million) had hypertension, 71% (5.5 million) had chronic kidney disease stage ≥2, 53% (4.3 million) were obese, 26% (2.1 million) had diabetes, 24% (2.0 million) had nephrolithiasis, 14% (1.2 million) had myocardial infarction, 11% (0.9 million) had heart failure, and 10% (0.9 million) had suffered a stroke. These proportions were substantially higher than those among individuals without gout (all P-values <.67). With increasing levels of hyperuricemia, there were graded increases in the prevalences of these comorbidities. In the top category (serum urate ≥10 mg/dL), 86% of subjects had chronic kidney disease stage ≥2, 66% had hypertension, 65% were obese, 33% had heart failure, 33% had diabetes, 23% had myocardial infarction, and 12% had stroke. These prevalences were 3-33 times higher than those in the lowest serum urate category (<4 mg/dL). Sex-specific odds ratios tended to be larger among women than men, and the overall comorbidity prevalence was highest among individuals with both gout and hyperuricemia.ConclusionsThese findings from the latest nationally representative data highlight remarkable prevalences and population estimates of comorbidities of gout and hyperuricemia in the US. Appropriate preventive and management measures of these comorbidities should be implemented in gout management, with a preference to strategies that can improve gout and comorbidities together.     

Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey

OBJECTIVE: To determine the prevalence of metabolic syndrome among patients with gout and to examine the association between the 2 conditions in a nationally representative sample of US adults. METHODS: Using data from 8,807 participants age >or=20 years in the Third National Health and Nutrition Examination Survey (1988-1994), we determined the prevalence of metabolic syndrome among individuals with gout and quantified the magnitude of association between the 2 conditions. We used both the revised and original National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria to define metabolic syndrome. RESULTS: The prevalence (95% confidence interval [95% CI]) of metabolic syndrome according to revised NCEP/ATP III criteria was 62.8% (51.9-73.6) among individuals with gout and 25.4% (23.5-27.3) among individuals without gout. Using 2002 census data, approximately 3.5 million US adults with a history of gout have metabolic syndrome. The unadjusted and age- and sex-adjusted odds ratios (95% CI) of metabolic syndrome for individuals with gout were 4.96 (3.17-7.75) and 3.05 (2.01-4.61), respectively. With the original NCEP/ATP criteria, the corresponding prevalences were slightly lower, whereas the corresponding odds ratios were slightly higher. The stratified prevalences of metabolic syndrome by major associated factors of gout (i.e., body mass index, hypertension, and diabetes) remained substantially and significantly higher among those with gout than those without gout (all P values <0.05). CONCLUSION: These findings indicate that the prevalence of metabolic syndrome is remarkably high among individuals with gout. Given the serious complications associated with metabolic syndrome, this frequent comorbidity should be recognized and taken into account in long-term treatment and overall health of individuals with gout.     

Prevalence and Factors Associated With Statin Use Among a Nationally Representative Sample of US Adults: National Health and Nutrition Examination Survey, 2011–2012

The 2013 American College of Cardiology/American Heart Association guidelines recommend statins for adults age ≤75 years who have clinical atherosclerotic cardiovascular disease (IA) and adults age 40 to 75 years with diabetes mellitus and LDL‐C 70–189 mg/dl (IA). Our aim was to estimate the prevalence and likelihood of statin use among selected statin benefit groups. Using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2012, we examined 5319 adults age ≥20 years. We estimated weighted frequencies and prevalence of statin use for adults with diabetes mellitus and dyslipidemia (or low‐density lipoprotein cholesterol ≥70 mg/dL), defined as statin benefit group 1 (SBG1); and for adults with atherosclerotic cardiovascular disease, defined as statin benefit group 2 (SBG2). We constructed a logistic regression model to estimate odds of statin use in SBG1. Overall, an estimated 38.6 million Americans are on a statin. In adjusted models, uninsured and Hispanic adults were less likely to be on a statin compared with white adults; 59.5% (95% confidence interval [CI]: 53.0‐66.1) of all adults in SBG1, 58.8% (95% CI: 51.5‐66.1) of adults age 40 to 75 in SBG1, and 63.5% (95% CI: 55.6‐71.4) of all adults in SBG2 were on a statin. Although the prevalence of statin use has increased over time, Hispanic ethnicity and lack of insurance remain barriers to statin use. Black‐white racial disparities were not significant. Our study provides a baseline estimate of statin use in the noninstitutionalized population just prior to introduction of the new guidelines and provides a reference for evaluating the impact of the new guidelines on statin utilization.     

Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008

Background and objective: Because the mortality and social burden associated with COPD is increasing, repeated surveys of the prevalence of COPD have been used to assess risk factors, detect potential patients, and establish early diagnoses and management protocols. We report the prevalence of spirometrically detected COPD in Korea in 2008, using data from the fourth Korean National Health and Nutrition Survey. Methods: Using nationwide stratified random sampling, based on the Korean Statistical Office census, 6840 subjects aged ≥19 years underwent spirometry, which was performed by four trained technicians, during 2008. The place of residence, levels of education and income and smoking status, as well as other results from a COPD survey questionnaire were also assessed. Results: Airflow obstruction (FEV₁/FVC < 0.7) was detected in 8.8% of subjects aged ≥19 years (11.6% of men and 5.9% of women) and COPD was detected in 13.4% of subjects aged ≥40 years (19.4% of men and 7.9% of women). Of the 6840 subjects, 27.3% were current smokers and 17.2% were former smokers, and the prevalence of COPD was higher in current and former smokers than in never smokers. Approximately 94% of patients with COPD had mild‐to‐moderate disease, without apparent symptoms; only 2.4% had been diagnosed by a physician and only 2.1% of patients had been treated. The independent risk factors for COPD were smoking, advanced age and male gender. Conclusions: Although the prevalence of COPD in Korea is high, the disease is underdiagnosed and most COPD patients are under‐treated.     

Seroprevalence of herpes simplex virus 2 among Hispanics in the USA: National Health and Nutrition Examination Survey, 2007-2008

To examine the seroprevalence of herpes simplex virus type 2 (HSV-2) among Hispanics in the USA, we used the cross-sectional, nationally representative National Health and Nutrition Examination Survey to compare the seroprevalence of HSV-2 between Hispanic persons of Mexican heritage and non-Mexican heritage aged 14-44 years, from survey years 2007-2008. The overall HSV-2 seroprevalence among Hispanics aged 14-44 years was 17.5% (95% confidence interval [CI], 15.2, 20.1) in the USA. HSV-2 seroprevalence was significantly lower among Mexican Americans than among other Hispanics (11.7% vs. 27.8%, P < 0.01). Prevalence of HSV-2 was also significantly associated with gender and age. The significant difference in HSV-2 seroprevalence between Hispanic persons of Mexican heritage and non-Mexican heritage suggested that targeting specific subgroups of Hispanics for preventive interventions may be a strategy to reduce the transmission of HSV-2 and HIV among Hispanics in the USA.     

Metabolic Syndrome and Chronic Laryngitis: The Korean National Health and Nutrition Examination Survey 2008 to 2010

Metabolic syndrome (MetS) is associated with a higher risk of morbidity and/or mortality for various chronic diseases. The aim of this study was to investigate the relationship of chronic laryngitis (CL) with MetS and its components in a representative Korean population.Data from the Korean National Health and Nutrition Examination Survey (2008–2010) were analyzed. A total of 10,360 adults who had undergone otolaryngological examination were evaluated.The prevalence of CL in the study population was 3.1%. The prevalence of MetS was significantly higher in patients with CL than in those without CL for both sexes (men: 34.7 ± 4.0% versus 25.9 ± 0.8%, P = 0.0235; women: 40.6 ± 5.3% versus 23.7 ± 0.7%, P = 0.0003). Elevated fasting glucose, triglycerides, and blood pressure, however, were only significantly associated with CL in women. After controlling for confounders, CL was only significantly associated with MetS in women (odds ratio: 2.159; 95% confidence interval: 1.2974, 3.594). Furthermore, the association between CL and MetS was most robust in women who were classified as obese.In Korea, MetS and its components are significantly associated with CL in women.     

Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013‐2014

Dual‐energy X‐ray absorptiometry (DXA) is a low‐cost, minimal radiation technique commonly used to assess bone density and body composition that can also provide a measure of abdominal aortic calcification (AAC). We examined the association between pulse pressure (PP) and DXA‐derived AAC in a nationally representative sample of US adults. Analyses were performed in 2,478 adults from the 2013‐2014 NHANES cycle. AAC scores were calculated using a validated 24‐point scale from thoraco‐lumbar spine images (scored 1‐6 across four vertebral heights from L1‐L4 for both anterior and posterior aortic walls). We examined PP as a predictor of both the presence (dichotomous) and magnitude (continuous) of AAC in age‐stratified analyses (<60 years of age and ≥60 years of age) adjusting for traditional cardiovascular disease risk factors, sex, mean arterial pressure and additionally for age and antihypertensive medication. The prevalence of AAC was 25.5%. PP was a predictor of the presence of AAC in fully adjusted models in adults <60 years of age (OR 1.31, P < .05) and ≥60 years of age (OR 1.33, P < .05). PP was also associated with the magnitude of AAC in the overall sample but did not retain significance after separating by age‐groups and additionally adjusting for antihypertensive medication. In conclusion, PP is associated with the presence of AAC as measured by DXA in a nationally representative sample of US adults.     

The relationship between hyperuricemia and anemia and metabolic syndrome in Korean adults: The Korea National Health and Nutrition Examination Survey 2019

AimThe present study was conducted to assess the relationship between hyperuricemia and anemia in Korean adults with or without metabolic syndrome (MetS).MethodsData from 6073 adults (age ≥ 20 years) in the Eighth Korean National Health and Nutrition Examination Survey (2019) were analyzed.ResultsSeveral key findings were identified. First, after adjusting for the related variables, the hemoglobin [Hb] level in the hyperuricemia subgroup (uric acid [UA] ≥ 7.0 mg/dL in men or ≥ 6.0 mg/dL in women) was higher than in the normouricemia subgroup (UA < 7.0 mg/dL in men or < 6.0 mg/dL in women) in subjects with non-MetS (p = 0.005), whereas it was lower than in the normouricemia subgroup in subjects with MetS (p = 0.032). Second, after adjusting for the related variables, the odds ratio (OR) of anemia (Hb < 13.0 g/dL in men or < 12 g/dL in women), using the normouricemia subgroup as a reference, was negatively significant for the hyperuricemia subgroup in subjects with non-MetS (OR, 0.478; 95 % CI, 0.300–0.761) but positively significant for the hyperuricemia subgroup in subjects with MetS (OR, 1.765; 95 % CI, 1.160–2.198).ConclusionsHyperuricemia was associated with a decrease in anemia in non-MetS but an increase in anemia in MetS.     

Hyperhomocysteinemia and hypercholesterolemia associated with hypothyroidism in the third US National Health and Nutrition Examination Survey

Hypothyroid (thyroid stimulating hormone (TSH)> or =20 mIU/l; N=32) participants in the third National Health and Nutrition Examination Survey, Phase 2 (1991-1994) were compared with non-hypothyroid subjects (0.5 mIU/l12 micromol/l) and hypercholesterolemia (serum total cholesterol>6.2 mmol/l). After controlling for age, gender, and race ethnicity, the odds ratios (95% confidence interval (CI)) relating hypothyroidism to hyperhomocysteinemia and high total cholesterol were 4.9 (1.8-14.0) and 8.0 (2.9-21.9), respectively. Based on 26 hypothyroid and 5811 non-hypothyroid subjects with triglyceride concentration < or =2.82 mmol/l, the odds ratio for the relationship between hypothyroidism and high low-density lipoprotein (LDL)-cholesterol (>4.6 mmol/l by the Friedewald equation) was 5.3 (95% CI, 1.3-20.9). Adding additional terms to the multivariate logistic regression model had little effect on the odds ratios relating hypothyroidism to high total or LDL-cholesterol, but adding terms for serum creatinine concentration >123.8 micromol/l and for red blood cell folate and serum vitamin B-12 concentrations resulted in an attenuated, but still significant (P<0.05), odds ratio relating hypothyroidism to hyperhomocysteinemia (2.5; 95% CI, 1.0-6.1). Controlling for cigarette smoking, heart attack/stroke history, body mass index, and serum albumin concentration did not affect the odds ratios. Hyperhomocysteinemia and hypercholesterolemia could help to explain the increased risk for arteriosclerotic coronary artery disease in hypothyroidism.