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Cardiovascular risk management in gout patients: do patients benefit from screening in secondary care?
Daisy Vedder1, Maaike Heslinga2, Carla A Wijbrandts3
1Amsterdam Rheumatology and Immunology Center Reade, Amsterdam; and Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. d.vedder@reade.nl.
Insights
Gout patients in secondary care have a high prevalence of cardiovascular disease (CVD) risk factors. Standard screening and recommendations did not improve CVD risk over one year, highlighting the need for rheumatologist involvement.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Public Health
Background:
- Gout patients frequently exhibit traditional cardiovascular disease (CVD) risk factors.
- Secondary care settings reveal a high burden of these risk factors among gout patients.
Purpose of the Study:
- To assess the 10-year CVD risk in gout patients receiving secondary care.
- To determine the impact of CVD risk screening on this risk after one year.
Main Methods:
- A prospective cohort study involving gout patients.
- Collected data on gout, CVD history, risk factors, medication, and lifestyle at baseline and 1-year follow-up.
- Calculated 10-year CVD risk using the NL-SCORE; analyzed differences with paired t-tests and McNemar tests.
Main Results:
- High prevalence of traditional CVD risk factors observed in gout patients.
- 19% of patients without prior CVD were classified as high-risk by NL-SCORE.
- CVD prevalence increased from 16% to 21% over one year; LDL cholesterol decreased, but BMI, blood pressure, and NL-SCORE did not improve.
Conclusions:
- The high prevalence of risk factors underscores the necessity of CVD risk screening in gout patients.
- Patient and GP recommendations alone were insufficient to improve CVD risk factors or the 10-year CVD risk.
- A greater role for rheumatologists is crucial for optimizing CVD risk management in gout patients.
Objectives:
To estimate the 10-year cardiovascular disease (CVD) risk in gout patients in secondary care and to evaluate the effect of CVD risk screening on the 10-year CVD risk after 1 year.
Methods:
A prospective cohort study was performed in patients with gout from Reade Amsterdam. Data on gout and CVD history, traditional risk factors, medication, and lifestyle were collected at baseline and 1 year. The 10-year CVD risk was calculated with the use of the NL-SCORE. A paired sample t-test and McNemar test was performed to test for differences between baseline and the 1-year visit.
Results:
A very high prevalence of traditional CV risk factors was seen in our secondary care gout patients. Nineteen percent without previous CVD were categorised in the high-risk group according the NL-SCORE. The prevalence of CVD increased from 16% to 21% after 1-year follow-up. A decrease was seen in total- and LDL-cholesterol after 1 year. No decrease in mean BMI, waist-hip ratio, blood pressure or NL-SCORE was observed.
Conclusions:
The current need for CVD risk screening of gout patients in secondary care was illustrated by the high prevalence of traditional risk factors in this cohort. Recommendations to patients and the general practitioner (GP) alone did not result in overall improvement of traditional CVD risk factors nor the 10-year CVD risk. Our results indicate that a more prominent role of the rheumatologist is necessary to optimise the process of initiation and management of CVD risk in gout patients.
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