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Gout, just a nasty event or a cardiovascular signal? A study from primary care
H J E M Janssens1, E H van de Lisdonk, H Bor
1University Medical Centre, Department of General Practice and Family Medicine 229, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Insights
Gout is linked to cardiovascular diseases and risk factors like hypertension and obesity. However, gout itself is not an independent predictor of cardiovascular disease development.
Area of Science:
- Cardiology
- Rheumatology
- General Practice
Background:
- Gout is a common inflammatory arthritis characterized by hyperuricemia.
- Cardiovascular diseases (CVD) are a leading cause of morbidity and mortality worldwide.
- The relationship between gout and CVD requires further investigation.
Purpose of the Study:
- To investigate the association between gout and cardiovascular diseases.
- To examine the link between gout and cardiovascular risk indicators.
Main Methods:
- A case-control study involving 261 gout patients and 522 matched controls from Dutch general practices.
- Follow-up study to assess the incidence of cardiovascular morbidity in gout patients.
- Outcome measures included prevalence and incidence of cardiovascular diseases, hypertension, diabetes mellitus, obesity, and hypercholesterolemia.
Main Results:
- Gout patients exhibited a higher prevalence of prevalent cardiovascular diseases compared to controls.
- Patients with gout showed significantly higher rates of hypertension, hypercholesterolemia, and obesity.
- Gout was not identified as an independent determinant for the development of cardiovascular disease after adjusting for risk factors.
Conclusions:
- Gout is associated with cardiovascular diseases and risk indicators.
- Gout itself is not an independent risk factor for developing cardiovascular disease.
- A gout diagnosis warrants a comprehensive assessment of a patient's cardiovascular risk profile.
Objective:
Our aim was to examine the relationship between gout on the one hand and cardiovascular diseases and cardiovascular risk indicators on the other.
Methods:
A case-control study was carried out in an aggregate primary care population of approximately 12 000 patients from four Dutch general practices, with follow-up of the cases free of cardiovascular diseases at the time of the first registered episode of gout. The subjects comprised 261 patients with a first episode of gout, 170 of whom were without prevalent cardiovascular diseases, and two control patients for each case matched for age, sex and practice. In the case-control study, the main outcome measures were the prevalence of cardiovascular morbidity (angina pectoris, myocardial infarction, heart failure, cerebrovascular accident, transient ischaemic attack, peripheral vascular disease), hypertension, diabetes mellitus, obesity and hypercholesterolaemia; in the follow-up study, the main outcome measure was the incidence of cardiovascular morbidity.
Results:
Thirty-five percent of 261 gout patients and 26% of 522 controls had one or more prevalent cardiovascular diseases. Compared with controls, patients had a higher prevalence of hypertension (43% versus 18%), hypercholesterolaemia (14% versus 6%) and obesity (56% versus 30%). A total of 170 gout patients without prevalent cardiovascular diseases (compared with 340 controls) had a higher prevalence of hypertension (39% versus 14%), hypercholesterolaemia (8% versus 4%), diabetes mellitus (5% versus 1%) and obesity (52% versus 27%). The first occurrence of a cardiovascular disease (real end-point) was seen in 26% of the patients free of cardiovascular morbidity and in 21% of the controls. This difference was not significant. In a Cox proportional hazard model, controlling for the cardiovascular risk indicators, gout did not prove to be an independent determinant for the development of cardiovascular disease.
Conclusion:
Gout was found to be associated with cardiovascular diseases and with cardiovascular risk indicators, without evidence of it being an independent risk indicator itself. A gout attack should be an incentive to assess the cardiovascular risk profile, when a patient seeks medical help.