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Cardiovascular disease is among the leading causes of mortality in the world1 and its prevalence is rising over time.2 Inflammatory disorders such as rheumatoid arthritis and others are commonly associated with a higher risk and an earlier onset of cardiovascular disease. This increased risk may be mediated at least partially by non-traditional cardiovascular risk factors (inflammation and other disease activity factors), in addition to the traditional cardiovascular risk factors.3 ,4
In a study by Clarson et al,5 the authors found that gout was a risk factor in women for incident coronary heart disease, any vascular event and peripheral vascular disease, but not cerebrovascular disease. The cardiovascular risk associated with gout was lower in men. The study used the Clinical Practice Research Database (CPRD) that includes 3.5 million people in the UK from general practices, stated by the authors to be representative of the general population with gout. The authors compared 8386 patients with gout with 39 766 non-gout patients. Despite the strengths of this study, including a large sample size, exclusion of patients with previously known heart disease and adjustment for important covariates, the study's findings must be interpreted in the light of two important limitations. First, the diagnoses of gout and most cardiac outcomes were not validated, but obtained from primary care records, which are likely to lead to some misclassification. Second, from an epidemiologic perspective, some people with disease may not seek care despite having access to healthcare due to either low/intermittent disease activity or personal health beliefs; also, there may be surveillance or detection bias because patients with gout may be more likely to visit primary care physicians than those who are healthy or do not have gout. Thus, the study's findings may be generally applicable to the UK population, but one may …