Abstract
Smoking has been found to be negatively correlated with serum uric acid levels by virtue of reduced production and increased consumption of endogenous antioxidant uric acid among smokers and has been reported to decrease incidence of gout. To shed further light on the question of association between active smoking and acute gout by examining this association using a large inpatient US database, using the Nationwide Inpatient Sample data from 2009 to 2011, we identified current smokers based on the International Classification of Diseases, Ninth Revision (ICD-9) code 305.1 and were assumed to have ceased smoking during hospital stay. Patients who developed acute gout inhospital were identified based on ICD-9 code 274.01 at secondary diagnosis position. Univariate and multivariate logistic regressions were used to derive odds ratio for measures of association. Statistical analysis was done using STATA version 13.0 (College Station, TX). A total of 17,847,045 discharge records were used which included 13,932 (0.08 %) inhospital acute gouty arthritis and 2,615,944 (14.66 %) active smokers. Both univariate (OR 0.59, CI 0.54–0.63, p < 0.0001) and multivariate (OR 0.64, CI 0.59–0.68, p < 0.0001) regressions showed statistically significant reduction of acute gout among hospitalized patients who were current smokers but were assumed to have ceased smoking during hospital stay. Active tobacco use was associated with a lower risk of acute inpatient gouty arthritis, even when controlling for conventional risk factors. More study is needed to correlate this finding with uric acid levels, and a better understanding of the mechanisms that explain this finding are necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Goldbourt U, Medalie JH (1977) Characteristics of smokers, non-smokers and ex-smokers among 10, 000 adult males in Israel ii. Physiologic, biochemical and genetic characteristics. Am J Epidemiol 105(1):75–86
Tsuchiya M, Asada A, Kasahara E, Sato EF, Shindo M, Inoue M (2002) Smoking a single cigarette rapidly reduces combined concentrations of nitrate and nitrite and concentrations of antioxidants in plasma. Circulation 105(10):1155–1157. doi:10.1161/hc1002.105935
Hanna BE, Hamed JM, Touhala LM (2008) Serum uric acid in smokers. Oman Med J 23(4):269–274
Haj Mouhamed D, Ezzaher A, Neffati F, Douki W, Gaha L, Najjar MF (2011) Effect of cigarette smoking on plasma uric acid concentrations. Environ Health Prev Med 16(5):307–312. doi:10.1007/s12199-010-0198-2
Juraschek SP, Tunstall-Pedoe H, Woodward M (2014) Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish heart health extended cohort study. Atherosclerosis 233(2):623–629. doi:10.1016/j.atherosclerosis.2014.01.026
Wang W, Krishnan E (2015) Cigarette smoking is associated with a reduction in the risk of incident gout: results from the Framingham heart study original cohort. Rheumatol Oxf Engl 54(1):91–95. doi:10.1093/rheumatology/keu304
Wiley LK, Shah A, Xu H, Bush WS (2013) ICD-9 tobacco use codes are effective identifiers of smoking status. J Am Med Inform Assoc JAMIA 20(4):652–658. doi:10.1136/amiajnl-2012-001557
Baron JA (1996) Beneficial effects of nicotine and cigarette smoking: the real, the possible and the spurious. Br Med Bull 52(1):58–73
Mahid SS, Minor KS, Soto RE, Hornung CA, Galandiuk S (2006) Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 81(11):1462–1471. doi:10.4065/81.11.1462
Freedman DS, Williamson DF, Gunter EW, Byers T (1995) Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I epidemiologic follow-up study. Am J Epidemiol 141(7):637–644
Rich MW (2000) Uric acid: is it a risk factor for cardiovascular disease? Am J Cardiol 85(8):1018–1021
Meisinger C, Koenig W, Baumert J, Döring A (2008) Uric acid levels are associated with all-cause and cardiovascular disease mortality independent of systemic inflammation in men from the general population: the MONICA/KORA cohort study. Arterioscler Thromb Vasc Biol 28(6):1186–1192. doi:10.1161/ATVBAHA.107.160184
Schretlen DJ, Inscore AB, Jinnah HA, Rao V, Gordon B, Pearlson GD (2007) Serum uric acid and cognitive function in community-dwelling older adults. Neuropsychology 21(1):136–140. doi:10.1037/0894-4105.21.1.136
Maxwell AJ, Bruinsma KA (2001) Uric acid is closely linked to vascular nitric oxide activity. Evidence for mechanism of association with cardiovascular disease. J Am Coll Cardiol 38(7):1850–1858
Waring WS, McKnight JA, Webb DJ, Maxwell SRJ (2006) Uric acid restores endothelial function in patients with type 1 diabetes and regular smokers. Diabetes 55(11):3127–3132. doi:10.2337/db06-0283
Teng GG, Pan A, Yuan J-M, Koh W-P (2015) Cigarette smoking and risk of incident gout in the Singapore Chinese health study. Arthritis Care Res. doi:10.1002/acr.22821
Longo D, Feldman M, Kruse R, Brownson R, Petroski G, Hewett J (1998) Implementing smoking bans in American hospitals: results of a national survey. Tob Control 7(1):47–55
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Rights and permissions
About this article
Cite this article
Poudel, D.R., Karmacharya, P. & Donato, A. Risk of acute gout among active smokers: data from nationwide inpatient sample. Clin Rheumatol 35, 3015–3018 (2016). https://doi.org/10.1007/s10067-016-3415-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-016-3415-6