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Cardiovascular disease risk factor assessment and management in gout: an analysis using guideline-based electronic
Keith Colvine1, Andrew J Kerr, Andrew McLachlan
1Department of Medicine, North Shore Hospital, Shakespeare Road, Private Bag 93-503, Takapuna, Auckland, New Zealand. keith.colvine@waitematadhb.govt.nz
Insights
Patients with gout have a high risk of cardiovascular disease (CVD). Many have modifiable risk factors, indicating a need for integrated CVD screening and management programs in rheumatology care.
Area of Science:
- Rheumatology
- Cardiology
- Preventive Medicine
Background:
- Gout is associated with an increased risk of cardiovascular disease (CVD).
- Effective management of gout patients requires addressing comorbid conditions, particularly CVD risk factors.
Purpose of the Study:
- To evaluate the prevalence of cardiovascular disease (CVD) risk and the need for risk management strategies in patients with gout.
- To assess the current management of CVD risk factors in gout patients referred to secondary care.
Main Methods:
- A cohort of 100 consecutive gout patients referred to rheumatology was studied.
- Cardiovascular disease (CVD) risk factors and management data were collected.
- PREDICT CVD software was used to calculate 5-year Framingham CVD risk and analyze therapeutic targets.
Main Results:
- 59% of patients had a high or very high 5-year CVD risk.
- Among high-risk patients, targets for blood pressure (34%), LDL-cholesterol (49%), and HDL-cholesterol (56%) were frequently unmet.
- Smoking cessation was achieved in 81% of high-risk patients. For diabetic patients, target HbA1c was reached in 40%.
Conclusions:
- Gout patients in secondary care settings exhibit a high burden of cardiovascular disease (CVD) risk and modifiable risk factors.
- Implementing CVD screening and management programs for gout patients could yield significant therapeutic benefits.
Aim:
To assess the need for cardiovascular disease (CVD) risk management in patients with gout.
Methods:
We studied 100 consecutive patients referred to the rheumatology service for management of gout. CVD risk factor and management data were collected. PREDICT CVD decision support software was used to calculate Framingham 5-year CVD risk, and to analyse therapeutic targets.
Results:
Fifty-nine (59%) patients had a high (>15%) or very high (> or = 20%) 5-year CVD risk. For those at high risk of CVD, target systolic blood pressure was achieved in 34%; target LDL-cholesterol in 49%, target HDL-cholesterol in 56%; and 81% did not smoke. For patients with diabetes, target HbA1c was reached in 40%. For high-risk individuals only 50% of eligible patients were on aspirin, 64% on beta-blockers, 53% statins, and 65% ACE inhibitors. There were no significant differences in duration of gout, presence of tophaceous disease, use of urate-lowering therapy or C-reactive protein between patients at high risk of CVD, and those with lower risk.
Conclusions:
Patients with gout referred to secondary care are at high risk for CVD, and have a large burden of modifiable risk factors. Implementation of CVD screening and management programs in these patients should have high therapeutic yield.
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