Cardiovascular risk in patients with new gout: should we reclassify the risk?
Mihaela Gamala1, Johannes W G Jacobs2, Suzanne P Linn-Rasker3
1Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and Department of Rheumatology, Northwest Clinics, Alkmaar and Den Helder, The Netherlands. m.gamala@umcutrecht.nl.
Insights
Adding gout to cardiovascular risk scores significantly reclassifies risk in new patients. This chronic inflammatory disease impacts 10-year cardiovascular event prediction, highlighting the need for updated risk assessment tools.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Chronic inflammation, exemplified by gout, is increasingly linked to heightened cardiovascular event (CVE) risk.
- Existing cardiovascular risk prediction models may not fully account for the impact of chronic inflammatory diseases.
Purpose of the Study:
- To evaluate the impact of incorporating gout as a chronic inflammatory condition into the Dutch SCORE risk prediction tool.
- To assess the reclassification of 10-year cardiovascular mortality and morbidity risk in gout patients.
Main Methods:
- A cross-sectional substudy included new gout patients meeting EULAR/ACR criteria.
- Patients underwent cardiovascular risk assessment using the Dutch SCORE, both with and without considering gout.
- Chi-square test for trends analyzed the significance of risk reclassification.
Main Results:
- Of 60 assessed gout patients, 16 had prior CVEs.
- Incorporating gout led to significant risk reclassification: 38.3% of patients were moved to a higher risk category.
- Specifically, 10% shifted from low to moderate, 18.3% from low to high, and 10% from moderate to high risk (p<0.001 for trend).
Conclusions:
- Adding gout to risk prediction models results in significant and clinically relevant cardiovascular risk reclassification.
- Further longitudinal studies are necessary to validate these findings in larger gout patient cohorts.
Objectives:
Chronic inflammation, as seen in gout, may contribute to an increased risk of developing cardiovascular (CV) events (CVE). The aim of the study was to explore the effect of adding gout as a chronic inflammatory disease to the Dutch SCORE, a tool predicting 10-year CV mortality and morbidity.
Methods:
This was a cross-sectional substudy including new patients with gout according the 2015 EULAR/ACR classification criteria who had participated in a trial on diagnostic accuracy of DECT with mono or oligoarthritis. Patients underwent a structured CV consultation, including assessment of CVE-history and of CV risk factors with the Dutch risk prediction SCORE. Chi-square test for trends was used to test for significance reclassification of the CV risk before and after adding gout to the Dutch SCORE.
Results:
Seventy-six gout patients were included. SCORE was applied in 60 patients; 16 patients had experienced a prior CVE. The 10-year risk scores without gout as risk factor were high in 29 patients (48.3%), moderate in 6 (10%) and low in 25 (41.7%); with gout, the risk of 23/60 patients (38.3%) was reclassified from low to moderate in 6 patients (10%), from low to high in 11 (18.3%) and from moderate to high in 6 (10%), p<0.001 for trend.
Conclusions:
Adding gout to the risk prediction tools led to significant and clinically relevant reclassification of CV risk in new gout patients. Studies with large follow-up are warranted to validate these findings.
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