Metabolic syndrome and ischemic heart disease in gout
Janitzia Vázquez-Mellado1, Conrado García García, Silvia Guzmán Vázquez
1Departments of Rheumatology, Hospital General de México, México. jvazquezmellado@prodigy.com.mx
Insights
Metabolic syndrome is highly prevalent in gout patients, with 82% affected. A significant 16% of these patients, previously asymptomatic, showed signs of ischemic heart disease (IHD), all of whom had metabolic syndrome.
Area of Science:
- Cardiology
- Rheumatology
- Metabolic Diseases
Background:
- Gout has long been linked to metabolic abnormalities and ischemic heart disease (IHD).
- Understanding the co-occurrence of metabolic syndrome and IHD in gout patients is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To determine the prevalence of metabolic syndrome and IHD in patients with primary gout.
- To investigate the relationship between metabolic syndrome components and IHD in this patient group.
Main Methods:
- Evaluated 64 new outpatients with primary gout without prior IHD history.
- Assessed metabolic syndrome using Adult Treatment Panel III (ATP III) criteria, including measurements of glucose, lipids, blood pressure, and obesity.
- Diagnosed IHD using electrocardiogram (EKG) and/or single-photon emission computed tomography (SPECT) with Tc-sestamibi.
Main Results:
- Metabolic syndrome was highly prevalent (82%) among gout patients.
- IHD was diagnosed in 16% of patients, all of whom presented with metabolic syndrome.
- Patients with IHD showed significantly different levels of HDL, glucose, insulin, and LDL compared to those without IHD.
Conclusions:
- Metabolic syndrome is very common in patients with gout.
- A notable percentage of gout patients, even if asymptomatic, have IHD, and all such cases are associated with metabolic syndrome.
- Rheumatologists play a key role in identifying metabolic syndrome and cardiovascular risk factors in gout patients.
Background:
For decades, gout has been associated with several metabolic abnormalities and with ischemic heart disease (IHD).
Objective:
Our aim was to determine the prevalence of metabolic syndrome by Adult Treatment Panel III criteria (ATP III) and ischemic heart disease (IHD) by electrocardiogram (EKG) and/or single photon emission computed tomography (SPECT) in patients with gout.
Methods:
We included 64 consecutive outpatients with primary gout, but no history of IHD, attending our clinic for the first time. Demographic and clinical data were recorded and resting electrocardiogram, lipid profile, fasting insulin, and SPECT with Tc sestamibi were performed. Metabolic syndrome was defined according to ATP III criteria (> or =3 of the following data: 1) hyperglycemia (fasting glucose > or =110 mg/dL) or previous diagnosis of diabetes mellitus, 2) hypertension (> or =130/85 mm Hg) or previous diagnosis, 3) high-density lipoprotein (HDL) <40 mg/dL (men) or <50 mg/dL (women), 4) triglycerides > or =150 mg/dL, and 5) obesity.
Results:
IHD was diagnosed in 10 patients (16%); 2 had EKG changes compatible with previous silent myocardial necrosis and the other 8 had abnormal SPECT. The prevalence of metabolic syndrome was 82%, all patients had at least 1 metabolic abnormality, but all the patients with IHD had metabolic syndrome (3 criteria according with ATP III). Patients with IHD differed from those without IHD in the percentage of HDL levels <40 mg/dL (100% vs. 82%; P = 0.05) as well as glucose and insulin levels in the fasting state (129.3 +/- 6.1 mg/dL vs. 92.7 +/- 16.7 mg/dL; P = 0.000; and 21.1 +/- 6.0 vs. 17.5 +/- 8.6 UI/mL; P = 0.03) and low-density lipoproteins (143.9 +/- 21.3 mg/dL vs. 118.2 +/- 47.7 mg/dL; P = 0.014). In contrast, serum creatinine and urea (1.02 +/- 0.13 mg/dL vs. 1.5 +/- 1.5 mg/dL; P = 0.024; and 33.9 +/- 9.3 mg/dL vs. 48.7 +/- 46.1 mg/dL; P = 0.039) and creatinine clearance <50 mL/min (10% vs. 37%; P = 0.06) were higher in patients without IHD.
Conclusions:
In this work, metabolic syndrome was very common among patients with gout. Sixteen percent of the patients, although previously asymptomatic, had IHD, they all had metabolic syndrome. Gouty patients frequently first seek medical care from a rheumatologist. The rheumatologist can have an important role in detecting metabolic syndrome and risk factors for cardiovascular disease.
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