Clinical research studyNature Versus Nurture in Gout: A Twin Study
Section snippets
Materials and Methods
All participants provided informed consent, and the original data collection was approved by institutional review boards of the participating sites. We used the data from the National Heart, Lung, and Blood Institute (NHLBI) twin study (NCT 00005124), presently housed at SRI International (Menlo Park, CA). The history and methodology of this cohort have been described.20, 21, 22 The NHLBI twin study was initiated in 1955 by the National Academy of Sciences/National Research Council, which
Results
The study subjects were twins enrolled in the NHLBI twin study (NCT 00005124). Table 1 provides the descriptive measures of the study cohort; 253 MZ and 261 DZ twin pairs were included. The baseline age range was 42 to 55 years. These individuals had been followed for a mean of 34 years. The last examination included 174 individuals (age range 76-86 years). The lifetime prevalence of gout (ie, prevalence anytime during observation in the study) did not differ significantly between MZ and DZ
Discussion
Our results confirm the previously reported strong heritability of hyperuricemia but suggest that environmental factors are more important in the phenotypic expression of gout. The difference in heritability between hyperuricemia and gout is not entirely surprising. Hyperuricemia, a critical predisposing factor for gout, is invariably present in gout but not vice versa. Vitart et al6 reported that only 10% of those with hyperuricemia eventually develop gout. The Normative Aging Study suggests
Conclusions
Our analysis of data collected on 514 male twin pairs through the NHLBI twin study suggests that the phenotype of gout is determined primarily by environmental factors. This has implications for prevention and treatment of the disease. Future larger twin studies must be performed to assess whether there is a detectable heritable component to gout and whether our observations are valid among women.
Acknowledgements
This work was supported by grant HL51429 from the National Heart, Lung, and Blood Institute. We acknowledge Dorit Carmelli, PhD (formerly of SRI International), Terry Reed, PhD (Indiana University Medical Center), Philip A. Wolf, MD (Boston University Medical Center) and Bruce L. Miller, MD (Harbor/UCLA Medical Center) for their rigor in overseeing data collection at their research sites.
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Funding: This study was supported by NHLBI grant HL51429.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.