Gout and rheumatoid arthritis, both to keep in mind in cardiovascular risk management: A primary care retrospective
Hein J E M Janssens1, Paul G J Arts2, Bianca W M Schalk2
1Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands; Primary health care center Lobede, Lobith-Tolkamer, The Netherlands.
Insights
Patients with gout and rheumatoid arthritis face increased cardiovascular disease risks. Gout patients show higher initial risk, while rheumatoid arthritis patients have a greater long-term risk, necessitating guideline integration.
Area of Science:
- Rheumatology
- Cardiology
- Primary Care Medicine
Background:
- Gout and rheumatoid arthritis are inflammatory conditions with potential systemic effects.
- Cardiovascular disease (CVD) is a leading cause of morbidity and mortality.
- The association between rheumatic diseases and CVD risk requires further elucidation in primary care settings.
Purpose of the Study:
- To evaluate and compare cardiovascular risks in patients diagnosed with gout versus rheumatoid arthritis within a Dutch primary care population.
- To assess the prevalence of cardiovascular risk factors and the incidence of CVD in these patient groups.
Main Methods:
- A retrospective matched cohort study utilizing electronic health records from 51 Dutch general practices.
- Inclusion of patients aged 30+ with incident gout (n=2655) or rheumatoid arthritis (n=513), matched with controls (n=7891 and n=1850).
- Comparison of baseline cardiovascular risk factors and follow-up for incident CVD using survival analyses.
Main Results:
- Gout patients exhibited significantly higher prevalence of hypertension, diabetes, hypercholesterolemia, and prior CVD compared to controls.
- Rheumatoid arthritis patients did not show significantly higher prevalence of these risk factors at baseline.
- Both gout (HR 1.44) and rheumatoid arthritis (HR 2.06) patients without prior CVD were at increased risk of developing incident CVD.
Conclusions:
- Gout and rheumatoid arthritis are independent risk factors for cardiovascular diseases.
- Rheumatoid arthritis presents a greater risk elevation, while gout patients already have an elevated cardiovascular risk profile at diagnosis.
- Recommendations for integrating gout and rheumatoid arthritis management into primary care cardiovascular risk guidelines are warranted.
Objectives:
To assess in one time window cardiovascular risks for both patients with gout and patients with rheumatoid arthritis in a Dutch primary care population.
Methods:
Retrospective matched cohort study with data from the electronic health records of 51 Dutch general practices. Participants were patients aged 30 years or older with an incident diagnosis of gout (n=2655) or rheumatoid arthritis (n=513), and matched non-disease controls (n=7891 and n=1850 respectively). At disease incidence date, patients and controls were compared for prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and prior cardiovascular diseases. Patients without prior cardiovascular disease were followed for a first cardiovascular disease, and compared to controls using Kaplan-Meier survival curves and Cox proportional hazard analyses.
Results:
Compared to controls, gout patients suffered more from hypertension (44.8%), diabetes (20.1%), hypercholesterolemia (13.7%), and prior cardiovascular disease (30%) (P<0.01), whereas rheumatoid arthritis patients (hypertension 28.5%; diabetes 11.7%; hypercholesterolemia 7.4%; prior cardiovascular disease 11.3%) did not (P>0.05). After adjustment, both gout and rheumatoid arthritis patients without prior cardiovascular disease were more likely to get a cardiovascular disease: hazard ratio (95% confidence interval) 1.44 (1.18 to 1.76), and 2.06 (1.34 to 3.16) respectively.
Conclusions:
This primary care study indicates that gout and rheumatoid arthritis are both independent risk factors for cardiovascular diseases, rheumatoid arthritis to some greater extent, whereas gout patients at first diagnosis had already an increased cardiovascular risk profile. It gives strong arguments for implementation of both rheumatic diseases in primary care guidelines on cardiovascular risk management.
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