What is the p-value of the 1.44 Hazard Ratio (HR) of thiazide in Table 2 in the study 'Diuretic Use, Increased Serum Urate and the Risk of Incident Gout in a Population-based Study of Hypertensive Adults: the Atherosclerosis Risk in the Communities (ARIC) Cohort'?

P-value of Thiazide HR 1.44 in ARIC Cohort Study

The p-value for the 1.44 hazard ratio of thiazide diuretic use in Table 2 of the study "Diuretic Use, Increased Serum Urate and the Risk of Incident Gout in a Population-based Study of Hypertensive Adults: the Atherosclerosis Risk in the Communities Cohort" is not provided in the available evidence.

Understanding Thiazide Diuretics and Gout Risk

While I cannot provide the specific p-value from the study mentioned in your question, I can provide relevant information about thiazide diuretics and their association with gout:

Mechanism of Thiazide-Induced Gout

Thiazide diuretics contribute to gout development through:

• Reduced renal uric acid excretion
• Volume depletion effects
• Dose-dependent risk

According to the American College of Rheumatology, thiazide diuretics are associated with an odds ratio of 1.72 (95% CI, 1.67-1.76) for developing gout 1.

Evidence from Other Studies

Several studies have demonstrated the relationship between thiazide diuretics and gout:

• A population-based case-control study found that current use of thiazide diuretics was associated with an adjusted OR of 1.70 (95% CI 1.62-1.79) for incident gout compared to past use 2.
• A retrospective cohort study of elderly patients found that thiazide diuretic therapy was associated with an adjusted relative risk of 1.99 (95% CI, 1.21-3.26) for initiation of anti-gout therapy 3.
• An internet-based case-crossover study found that thiazide diuretic use had an OR of 3.2 for recurrent gout attacks after adjusting for alcohol consumption and purine intake 4.

Dose-Dependent Risk

The risk for gout with thiazide diuretics appears to be dose-dependent:

• Significant increased risk was observed for thiazide doses of ≥25 mg/day (in hydrochlorothiazide equivalents)
• No significant increase in risk was seen for lower doses 3

Clinical Implications

Management Considerations

For patients requiring antihypertensive therapy:

1. Consider alternative first-line agents such as ACE inhibitors, ARBs, or calcium channel blockers for patients with a history of gout 1.
2. If thiazide diuretics must be used in patients at risk for gout:
   • Use the lowest effective dose
   • Regularly monitor serum uric acid levels
   • Consider prophylactic measures in high-risk patients

Risk Mitigation Strategies

For patients on thiazide diuretics:

• Implement lifestyle modifications (weight loss, reduced alcohol intake, limiting purine-rich foods)
• Monitor for signs of hyperuricemia and gout
• Consider calcium channel blockers or losartan as they may slightly attenuate the risk of gout in patients taking diuretics 2

Common Pitfalls and Caveats

1. Don't assume all diuretics carry equal risk: Loop diuretics have a higher association with gout (OR 2.64,95% CI 2.47-2.83) than thiazide diuretics 2.

2. Don't overlook combined diuretic therapy: Combined use of loop and thiazide diuretics carries the highest risk (adjusted OR 4.65,95% CI 3.51-6.16) 2.

3. Don't automatically discontinue thiazides: The benefits of blood pressure control may outweigh the risk of gout in many patients. Consider risk-benefit analysis and alternative strategies before discontinuation.

4. Don't ignore genetic factors: SU-associated genetic variants contribute strongly to gout risk in people taking diuretics, with a similar effect to that observed in those not taking diuretics 5.