Major cardiac event risk in gout rises with monosodium urate deposits on CT
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Key takeaways:
- Patients with cardiovascular monosodium urate deposits on CT were at higher risk for myocardial infarction, stroke and CV death.
- The findings may help risk stratification in patients with gout.
Among patients with gout, those with cardiovascular monosodium urate deposits, confirmed via dual energy CT, demonstrate a higher risk for major adverse cardiac events, according to data published in Rheumatology.
“Gout diagnosis results in a doubled risk for [cardiovascular] events,” Julia Held, MD, of the Medical University of Innsbruck, in Austria, and colleagues wrote. “Although patients with gout frequently suffer from typical CV risk factors, the higher hazard is not sufficiently explained and thus several studies suggest gout and hyperuricemia as independent risk factors for CV disease.
“Despite the rising incidence of gout and increased CV morbidity and mortality in affected patients, parameters highlighting individuals at risk are still lacking,” they added. “The association between CV [monosodium urate] deposits and major CV events (MACE) has not been evaluated so far.”
To examine those potential links, Held and colleagues conducted a retrospective cohort study of patients recruited at the Medical University of Innsbruck. Included patients had a clinical suspicion of gout and underwent dual energy CT for the affected limb and thorax between June 2012 and Dec. 5, 2019. The cohort included 131 patients with a final diagnosis of gout, 40 with hyperuricemia and 18 control individuals. Among the 189 patients with either gout or hyperuricemia, 85 (45%) demonstrated CV monosodium urate deposits.
The researchers evaluated CV risk factors from patient charts and analyzed the occurrence of MACE — defined as myocardial infarction, stroke or CV death — over a period spanning from January 2000 until each patient’s latest documented clinical contact before December 2022, when the analysis was performed.
Over a median follow-up time of 33 months beginning from CT scan, 35 patients (18.5%) experienced MACE. According to the researchers, prevalence was higher among patients who showed CV monosodium urate deposits vs. those who did not (OR = 2.4; P = .018).
Compared with patients who showed no CV monosodium urate deposits, those who did also demonstrated increased C-reactive protein (median 17.1 mg/L vs. 5.6 mg/L), uric acid levels (mean 7.4 mg/dL vs. 64.5 mg/dL) and coronary calcium scores (median 469.5 vs. 5.35).
“This is the first study demonstrating the higher hazard of major adverse cardiac events in patients with dual energy computed tomography-verified cardiovascular monosodium urate deposits,” Held and colleagues wrote. “The higher prevalence of cardiac events in patients with cardiovascular monosodium urate deposits may facilitate risk stratification of gout patients, as classical cardiovascular risk scores or laboratory markers fail in their proper identification.”
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