Gout and African Americans: Reducing disparities

Bharat Kumar; Petar Lenert

doi:10.3949/ccjm.83a.15133

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TABLE 1

Dietary factors in gout

Risk factor	Association with gout	Relevance to African Americans
Alcohol	Ethanol metabolism causes adenosine triphosphate consumption, leading to purine degradation and increased serum uric acid	Rates of alcohol use in African Americans are lower than in white Americans, but African Americans are more likely to have negative health consequences from excessive drinking than white Americans
Purine-rich foods	Excess purine is degraded to uric acid, leading to hyperuricemia	Meat consumption is higher among African Americans than white Americans
Sugary drinks	Fructose phosphorylation depletes phosphate, causing accumulation of uric acid	17% of African American adults obtain ≥ 25% of their calories from added sugars, compared with 11% of white adults
Dairy products	Beneficial: uricosuric effect of casein and lactalbumin	African Americans drink less milk than white Americans
Caffeine	Beneficial: uricosuric effect, antioxidant properties may increase insulin sensitivity, may inhibit xanthine oxidase
Vitamin C	Beneficial: direct uricosuric effect	African Americans eat less fruits and vegetables than white Americans
Cherries or cherry juice	Beneficial: anti-inflammatory effects of polyphenols

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TABLE 2

Modifiable risk factors and comorbidities of gout in African Americans

Risk factor or comorbidity	Association with gout	Relevance to African Americans	Potential interventions
Hyperlipidemia	Increases the risk of hyperuricemia	African Americans actually have lower total cholesterol levels and higher high-density lipoprotein levels than white adults	Fenofibrate lowers serum uric acid levels
Hypertension	40% of patients with gout have hypertension Serum uric acid levels may contribute to the pathogenesis of hypertension	African American adults have a higher prevalence of hypertension (42%) than white adults (28%)	Reconsider prescription of loop and thiazide diuretics, since these increase serum uric acid levels Losartan has mild uricosuric effects
Diabetes mellitus	Incidence of hyperuricemia and gout is increased in patients with prediabetes Glycosuria in advanced diabetes leads to a uricosuric effect, decreasing the incidence of gout	Mean hemoglobin A levels 1c are higher in African Americans (6.18%) than in white adults (5.78%) 11.3% of African American adults have diabetes mellitus, compared to 6.8% of white adults	Behavioral modification and pharmacotherapy to control diabetes may improve hyperuricemia as well
Obesity	Obesity produces a proinflammatory state conducive to hyperuricemia and gout	45% of African American adults are obese, compared to 32% of white adults	Weight loss may help to reduce uric acid levels.
Coronary artery disease	Patients with gout have a relative risk of 1.45 (95% confidence interval 1.19–1.75) of coronary artery disease	African Americans have earlier age of onset and higher overall mortality rate from coronary artery disease in all age groups	Aggressive risk factor reduction through counseling and pharmacotherapy
Chronic kidney disease	Renal underexcretion of uric acid is the most common cause of hyperuricemia Hyperuricemia leads to progression of renal disease	0.1% of African American adults have end-stage renal disease vs 0.024% of white adults	Use of allopurinol may help to slow the progression of renal disease Colchicine should be used with extreme caution in chronic kidney disease