Cardiovascular disease risk in gout highest for women, young people
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Key takeaways:
- Excess cardiovascular disease risk in patients with gout was highest among women and those aged younger than 45 years.
- Higher risk in patients with gout persisted after adjusting for cardiovascular risk factors.
Excess risk for cardiovascular disease in patients with gout — including heart failure and arrhythmias — is highest among women and those aged younger than 45 years, according to data published in The Lancet Rheumatology.
“Although numerous studies have assessed the association of gout with atherosclerotic cardiovascular disease, fewer high-quality studies have assessed its association with other cardiovascular diseases, such as valve disease, venous thromboembolism, heart failure, pericarditis and infective endocarditis,” Lyn D. Ferguson, PhD, of the University of Glasgow, in Scotland, and colleagues wrote. “Filling this evidence gap is important, given that such cardiovascular outcomes have become more common in many high-income countries due to reductions in adverse atherosclerotic outcomes.”
To understand more about how cardiovascular disease risk in gout varies across specific conditions, Ferguson and colleagues conducted a matched case-control study of electronic health records from the U.K. Clinical Practice Research Datalink. The researchers selected patients aged 80 years or younger at the time of their first gout diagnosis between 2000 and 2017. Included patients were free of cardiovascular disease for up to 12 months afterward. Each patient was compared with up to five matched controls randomly selected from individuals free of gout.
The researchers examined the prevalence of aortic aneurysm, cardiac arrythmias, heart failure, ischaemic heart disease, myocarditis and pericarditis, peripheral arterial disease, infective endocarditis, stroke, valve diseases and venous thromboembolism or pulmonary embolism. The study included 152,663 patients with gout, 20.6% of whom developed cardiovascular disease over a median follow-up of 6.5 years, as well as 709,981 matched controls, 15% of whom developed cardiovascular disease.
According to the researchers, Cox proportional hazard models revealed excess risk among patients with gout across all cardiovascular diseases under investigation. Patients with gout demonstrated a higher risk for cardiovascular disease than controls (HR = 1.58; 95% CI, 1.52-1.63), particularly among women (HR = 1.88; 95% CI, 1.75-2.02) and those aged 45 years or younger (HR = 2.22; 95% CI, 1.92-2.57).
Adjusting for cardiovascular risk factors such as blood pressure, BMI and smoking status “attenuated but did not eliminate” excess risk for cardiovascular disease related to gout (adjusted HR = 1.31; 95% CI, 1.27-1.36), the researchers wrote.
Ferguson and colleagues concluded that the excess cardiovascular risk “appeared to be only partly explained by traditional cardiovascular risk factors.”
“As such, the addition of gout into routinely used cardiovascular risk scores, such as QRISK, and its inclusion in cardiovascular disease prevention guidelines appears warranted,” they added. “Strategies to reduce cardiovascular risk in patients with gout need to be further developed and implemented.”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
It has long been suspected that gout is associated with a number of cardiovascular disorders. A large group of European patients with gout was compared with matched controls and found to have an excess number of participants with heart failure, arrhythmias, valve disease and thromboembolic disease, among other cardiovascular disorders. This has been suspected for some time, but this paper documents it with a detailed retrospective analysis.
There are a few concerns about this publication. First, no rheumatologist is listed as an author. Second, the diagnosis of gout is not defined, and no portion of charts were reviewed to confirm the percentage of 152,663 patients who fulfilled the criteria, rather than relying on ICD-10 attestation by a large number of practitioners. We do not know if the patients had a single attack, were diagnosed on the basis of hyperuricemia or had polyarticular gout. It also does not state why gout might correlate with these findings. Nevertheless, the conclusions should help health care planners focus on proactive interventions.
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