Background Cardiovascular (CV) disease affects gout patients. This is thought to result from a combination of an increase in CV risk factors and crystal-led inflammation. Despite being more prevalent in men, gout also has an impact on the CV risk of women (1). To date, few studies have focused on gender differences on gout, especially in terms of CV assessment.
Methods Observational, cross-sectional study. Consecutive newly-diagnosed crystal-proven gout patients seen in a tertiary hospital underwent a structured CV assessment which included risk prediction tools, carotid ultrasound and CV risk stratification according to current European guidelines. Gout features were also registered. A gender comparison in the different variables was performed, employing chi-2 tests for binary variables, and Student's t or Mann-Whitney's tests for quantitative variables.
Results A total of 199 patients - 28 (14.1%) women and 171 (85.9%) men - were analyzed. Women were significantly older than men (72.7± 11.1 years in women vs 62± 13.0 in men, p<0.001). In terms of CV risk factors, women had more commonly high blood pressure (89.3% vs 64.9%, p=0.01), diabetes (53.6% vs 18.7%, p<0.001), diuretic use (78.6% vs 38.2%, p<0.001), and chronic kidney disease (71.4% vs 21.3%, p<0.001). Smoking background was more frequent in men (20% vs 66%, p<0.001), and dyslipidemia rates were similar. Uric acid levels at diagnosis were higher (8.97 vs 7.82 mg/dL, p=0.001) in women. Regarding gout features, men showed longer disease duration (median (p25–75) 1 year (0–3.0) in women and 5 years (2.0–15.0) in men, p=0.005) and reported more gout attacks (2 attacks (1.0–3.5) in women and 5 (3.0–20.0) in men, p=0.001), with no differences between genders in the proportion of patients with tophi. No significant differences in carotid plaques were noted (50% in women and 33.6% in men, p=0.32), but ultrasound was often deemed unnecessary in women because they already presented a very high CV risk at assessment (64.3% of women and 33.7% of men, p=0.002). At final CV risk stratification, women tended to show higher CV risk than men (Figure 1).
Conclusions The CV profile of women with gout seems worse than male patients in this series. Differences in gout pathogenesis between genders likely explain these results. This finding highlights the need for an optimal CV management when dealing with female gout patients.
De Vera MA. Ann Rheum Dis 2010;69:1162
Disclosure of Interest None declared