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Quantitative Assessment of Baseline Serum HDL-C to Predict Gout Flares During Urate-Lowering Therapy Initiation: A
Chang Jiang1,2, Maichao Li1,2, Ying Chen3
1Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, People's Republic of China.
Insights
Lowering high-density lipoprotein cholesterol (HDL-C) levels increases gout flare risk. Maintaining HDL-C above 1.15 mmol/L may reduce gout flares, with a predictive model developed for risk assessment.
Area of Science:
- Rheumatology
- Lipid Metabolism
- Gout Pathophysiology
Background:
- Gout is a common inflammatory arthritis characterized by hyperuricemia and urate crystal deposition.
- Previous research suggests a link between high-density lipoprotein cholesterol (HDL-C) and gout, but the dose-response relationship with gout flares remains unclear.
- Initiating urate-lowering therapy (ULT) is a critical period for managing gout and preventing flares.
Purpose of the Study:
- To investigate the dose-effect relationship between serum HDL-C levels and gout flares during ULT initiation.
- To develop a predictive model for gout flares incorporating serum HDL-C levels and other clinical indicators.
Main Methods:
- A prospective, observational, single-center cohort study involving men with gout initiating ULT.
- Patients were stratified into low and high HDL-C groups at baseline (1.16 mmol/L cutoff) and followed for 12 weeks.
- Statistical analyses included restricted cubic splines and logistic regression to assess the association and develop a predictive equation.
Main Results:
- A total of 394 participants completed the study.
- The low HDL-C group exhibited a significantly higher proportion of gout flares (52.2%) compared to the high HDL-C group (35.6%) (P=0.001).
- Serum HDL-C demonstrated a negative linear association with gout flares, and a predictive model incorporating HDL-C achieved an AUC of 0.75.
Conclusions:
- Patients with gout show a negative linear relationship between serum HDL-C and gout flares.
- Maintaining serum HDL-C levels above 1.15 mmol/L may be protective against gout flares.
- A predictive model combining serum HDL-C with clinical factors improves gout flare prediction accuracy.
Purpose:
Previous studies have linked high-density lipoprotein cholesterol (HDL-C) to gout, but little is known about the dose-effect relationship between serum HDL-C levels and gout flares. This study aimed to quantify the association between the two during urate-lowering therapy initiation and develop a regression equation to predict gout flares.
Patients And Methods:
We conducted a prospective, observational, single-center cohort study of men with gout. Patients were identified and grouped according to the level of serum HDL-C (1.16 mmol/L) at baseline and followed-up every four weeks until 12 weeks.
Results:
A total of 394 participants completed the study (203 in the low HDL-C group; 191 in the high HDL-C group). The proportion of participants with gout flares in the low HDL-C group was significantly higher than in the high HDL-C group after 12 weeks follow-up (52.2% versus 35.6%, P=0.001). Patients with lower serum HDL-C level had higher risk of gout flares analyzed by restricted cubic spline and when serum HDL-C level = 1.15mmol/L, flareHR = 1. When combined with well-known risk factors, serum HDL-C predicted gout flares with an area under curve (AUC) of 0.75 (95% CI=0.70-0.80). Based on the logistic regression coefficients, we derived the following regression equation: Logit (P)= -2.282+0.05× [disease duration]+1.015× [recurrent flares in the last year]+0.698× [palpable tophus]+0.345× [serum urate]-1.349×[serum HDL-C].
Conclusion:
Patients with gout presented a negative linear relationship between serum HDL-C and gout flares. Together with common clinical indicators, the AUC for gout flare prediction increased to 0.75. For patients with gout, remaining serum HDL-C level above 1.15 mmol/L may reduce the risk of gout flares.
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