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 |
Information from references 2, 10, 12, 13, 21, 37, 47, 44, 46