Background Risk of cardiovascular (CV) events is increased in gouty population due to high prevalence of traditional CV risk factors, metabolic syndrome, hyperuricemia and chronic inflammation [1, 2].
Objectives To determine factors that affect the risk of CV events in male patients (pts) with crystal-proven gout.
Methods 251 male pts with crystal-proven gout were observed prospectively from 2003 to 2013. Еach patient had at list one hospitalization to clinic (1-5, mean 1.2 hospitalization). Mean follow-up period was 6.9±2.0 years (1 727 рatient-years). At the entry into the study the mean age of pts was 51.9±11.4 years. New CV events and CV deaths were recorded. Logistic regression was used to analyse “traditional” risk factors for CV events and other risk factors: metabolic syndrome, chronic kidney disease (CKD), ischemic heart disease (IHD), serum uric acid (UA) level, alcohol intake and serum high-sensitive C-reactive protein (hs-CRP) level. The risk of CV events in allopurinol users was estimated.
Results Clinical features at first/last visits demonstrated increase in IHD (35.5%/53.5%), diabetes mellitus (17.9%/44.6%), obesity (51.4%/72.1%), arterial hypertension (85.7%/92.4%)andCKD (12.0%/16.7%). The frequency of subcutaneous tophi (37.5%/39.4%) and chronic arthritis (30.7%/24.2%) at first/last visits was the same. Normouricemia (serum UA level<6 mg/dl) was achieved in 17.1% of pts. 52.9% of pts continued allopurinol treatment during follow-up period, mean dosage was 150±90 mg/day.
CV events were registrated in 58 pts (23.1%) and 30 of them received allopurinol regularly; CV death was registrated in 22 pts (8.8%) and 12 of them received allopurinol regularly.
The risk of all CV eventswas high for: arterial hypertension (odds ratio (OR) - 8.68 (95% CI 0.93-80.61), increased hs-CRP (>5 mg/l) (OR 5.71,1.57-20.77), CKD (OR 4.76, 1.62-13.99), alcohol intake(OR 4.23, 1.16-15.39), CAD (OR 3.67, 1.35-10.00), family history of premature CV events (OR 3.09, 1.32-7.25). Chronic gout arthritis (OR 1.36,0.60-3.11), serum UA level (OR 1.22, 0.48-3.14), subcutaneous tophi (OR 0.92, 0.42-2.01) did not affect the risk of CV events. The risk of fatal CV events was maximum for: hs-CRP (OR 14.26, 1.36-149.19), CKD (OR 8.42, 1.63-43.38), family history of the premature CV events (OR 7.53, 1.42-40.01). Only the highest quartile of serum UA level (UA>9.20 mg/dl) was associated with an increased risk of fatal CV events (OR 3.24, 0.83-12.55).
The regular use of allopurinol did not decrease the risk of CV events (OR 1.08, 0.63-1.87) and fatal CV events (OR 1.21, 0.51-2.85).
Conclusions Arterial hypertension, CKD, alcohol intake, CAD, family history of the premature CV events and high hs-CRP had a significant impact on the risk of development of CV events. Only highest levels of serum UA were associated with the risk of fatal CV events. Regular allopurinol use did not decrease the risk of development of CV events.
Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation. 2007 Aug 21;116(8):894-900.
Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, Lin CM, Chen HW, Yu KH. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2010 Jan;49(1):141-6.
Disclosure of Interest None Declared