Background Gout is associated with increased risk of Cardio-Vascular Disease and death.
Objectives To measure the frequencies of a number of potentially modifiable CVD risk factors in gout patients.
Methods Comorbidities and CVD risk factors were measured and registered in a cohort of 100 consecutive new crystal proven gout patients.
Results 88 males (62.1±13.6 years) and 12 females (74.1±6.9 years) were included. See table for results.
Conclusions Nephropathy, obesity, and dyslipidemia are known to correlate to hyperuricemia and gout. Reciprocally hyperuricemia and gout may lead to development of comorbidities, i.e. hypertension, CVD, and nephropathy.
Almost half the patients in this study were obese emphasizing the correlation between hyperuricemia and gout and obesity. Weight reduction is beneficial for control of hyperuricemia and gout, and is an important lifestyle factor that may be addressed in the treatment of hyperuricemia.
Metabolic Syndrome is characterized by abdominal obesity and at least two of the following criteria: hypertension, diabetes, hypertriglyceridemia, and low blood levels of high-density-lipoprotein. Metabolic Syndrome is associated with a two-fold risk of CVD and was present in 72% of the gout patients.
High homocysteine levels are correlated to endothelial dysfunction and increased risk of CVD. In this study the majority of patients had levels of homocysteine in the upper normal range, and a quarter had hyper-homocysteinemia. Elevated homocysteine has previously been reported in gout correlated to impaired renal function, but hyper-homocysteinmia can also be induced by low blood levels of cobalamin, which was present in 16%, and low levels of folate, which was found in 26%. In addition, low folate has been associated with endothelial dysfunction and CVD independently of homocysteine.
Low levels of 25(OH)-vitamin D3 were observed in nearly half of the gout patients and deficiency were found in 19%. Obesity is known to be associated with low levels of vitamin D. Negative correlation between uric acid and Vitamin D has though been reported after correction for weight. Uric acid suppresses 1-alpha hydroxylase leading to low levels of 1,25(OH)2-vitamin D3 which is correlated to dyslipidemia and Metabolic Syndrome. Urate Lowering Therapy has been shown to counteract suppression of 1-alpha hydroxylase.
Due to the increased risk of CVD and death associated with gout and the high prevalence of comorbidities and CVD risk factors in gout patients - comprehensive evaluation, information, and treatment of reversible co-morbidities and risk factors is recommended to be a part of the clinical management of gout.
Disclosure of Interest None declared
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