Background Gout is an inflammatory arthropathy characterised by elevated serum uric acid levels. In Australia, gout has a prevalence of 1.7 - 4%.1 This increased to ∼10% in community based Australian patients with type 2 diabetes, although elevated serum uric acid did not predict cardiovascular (CV) or all-cause mortality.2 To date, the long-term outcomes of patients with diabetes and comorbid gout being followed up in the hospital out-patient setting have not been studied.
Objectives To compare cardiovascular risk factors and long-term outcomes and mortality in patients with type 2 diabetes according to the presence or absence of gout.
Methods 1,405 patients with type 2 diabetes were prospectively recruited from the outpatient setting at Austin Hospital. Baseline cardiovascular risk factors and comorbidities were identified. Patients were classified as having gout if they gave a history of gout or were taking medication for the treatment of gout. For statistical analysis, patients with diabetes (Group 1) were compared to those with diabetes and gout (Group 2). Cardiovascular events and long-term CV mortality were assessed over a 10 year period.
Results There were 1,329 patients with diabetes (Group 1; 95%) and 76 with diabetes and gout (Group 2; 5%). Patients with gout were older (68±11 vs. 64±12y, p=0.004), more likely to be male (80% vs. 59%, p<0.0001), with higher triglyceride levels (2.6 vs 1.9 mmol/L, p=0.002), lower HDL (1.05 vs. 1.24 mmol/L, p<0.0001), higher BMI (33 vs. 31, p=0.026), and were more likely to have nephropathy (55% (n=35) vs. 26% (n=311), p<0.0001) with increased albumin creatinine ratio (3.4 vs 1.8 g/mmol, p=0.002). Despite the worse cardiovascular risk profile in those with gout and diabetes, cardiovascular events and all-cause mortality were not significantly different between the groups (Group 1, 27% (n=333) vs. 35% (n=23) in Group 2, p=0.201).
Conclusions Although patients with comorbid gout and type 2 diabetes have a worse cardiovascular risk factor profile compared to those with diabetes alone, this was not associated with increased cardiovascular morbidity or all-cause mortality. These results suggest that elevated uric acid and gout are markers rather than determinants of CV mortality.
Robinson PC, Taylor WJ, Merriman TR. Systemic review of the prevalence of gout and hyperuricaemia in Australia. Internal Med J 2012; 42(9):997–1007.
Ong G, Davis WA, Davis TME. Serum uric acid does not predict cardiovascular or all-cause mortality in type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2010; 53: 1288–129.
Disclosure of Interest None declared