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Is urate crystal precipitation a predictor of cardiovascular risk in hyperuricemic patients? A Danish cohort study
Kasper Søltoft Larsen1,2, Anton Pottegård3, Hanne Lindegaard4
1Department of Clinical Chemistry and Pharmacology, Odense University Hospital, DK-5000, Odense, Denmark. kaslarsen@health.sdu.dk.
Insights
Hyperuricemia and gout are linked to cardiovascular issues. This study found that urate crystal precipitation does not add extra cardiovascular risk in hyperuricemic patients.
Area of Science:
- Rheumatology
- Cardiology
- Clinical Epidemiology
Background:
- Hyperuricemia and gout are associated with increased cardiovascular morbidity and mortality.
- The independent contribution of urate crystal precipitation to cardiovascular risk in hyperuricemic individuals remains unclear.
Purpose of the Study:
- To determine if monosodium urate crystal precipitation itself increases cardiovascular disease risk in patients with hyperuricemia.
Main Methods:
- A cohort study matched hyperuricemic patients with and without intra-articular urate crystals using propensity scores.
- Potential confounders were identified from four healthcare registries for inclusion in the propensity score model.
Main Results:
- The study included 317 hyperuricemic patients with urate crystals matched 1:1 to 317 patients without crystals.
- No significant difference in composite cardiovascular outcomes (HR=0.86, 95% CI 0.52-1.43) or all-cause mortality (HR=0.74, 95% CI 0.45-1.21) was observed between the groups.
Conclusions:
- Urate crystal precipitation does not appear to confer additional cardiovascular risk beyond that associated with hyperuricemia itself.
Introduction:
There is increasing evidence that both hyperuricemia and gout increase the risk of cardiovascular morbidity and mortality. Whether urate crystal precipitation confers a particular risk above what is already inherent in having hyperuricemia is not well established. We conducted this cohort study to establish whether the presence of monosodium urate crystal precipitation per se is associated with increased risk of cardiovascular diseases among hyperuricemic patients.
Methods:
We identified hyperuricemic individuals who had joint fluid examinations for urate crystals. Individuals with intra-articular urate crystals were matched by propensity score to individuals without crystals and compared with respect to a composite cardiovascular endpoint. Included in the propensity score model were potential confounders retrieved from four different health care registries.
Results:
We identified 862 hyperuricemic patients having urate crystal examination. After propensity score matching, we could include 317 patients with urate crystals matched 1:1 to patients without urate crystals. We found no difference between the two groups with respect to cardiovascular outcomes (hazard ratios = 0.86; 95 % confidence interval (CI) 0.52 - 1.43) or death (hazard ratio 0.74; CI 0.45 - 1.21).
Conclusion:
The presence of urate crystal precipitations does not seem to confer a particular cardiovascular risk in hyperuricemic patients.
