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Extended report
Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment
  1. Mariano Andrés1,2,
  2. José Antonio Bernal1,
  3. Francisca Sivera3,
  4. Neus Quilis3,
  5. Loreto Carmona4,
  6. Paloma Vela1,2,
  7. Eliseo Pascual1,2
  1. 1 Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
  2. 2 Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
  3. 3 Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain
  4. 4 Instituto de Salud Musculoesquelética, Madrid, Spain
  1. Correspondence to Dr Mariano Andrés, Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, Alicante 03010, Spain; drmarianoandres{at}


Objectives Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk.

Methods Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools—the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves.

Results 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS.

Conclusions The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout.

  • Gout
  • Cardiovascular Disease
  • Atherosclerosis
  • Ultrasonography

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  • Handling editor Tore K Kvien

  • Contributors MA wrote the first draft of the manuscript. All authors contributed to the drafting of the manuscript and approved the final version.

  • Competing interests MA has received speaking fees from Menarini labs. EP has received consulting, speaker fees or grants from the following companies: Menarini, AstraZeneca, Savient, Procaps and Novartis.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee of Hospital General Universitario de Alicante (Spain).

  • Provenance and peer review Not commissioned; externally peer reviewed.