Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment

Andrés, Mariano; Bernal, José Antonio; Sivera, Francisca; Quilis, Neus; Carmona, Loreto; Vela, Paloma; Pascual, Eliseo

doi:10.1136/annrheumdis-2016-210357

Cited by 43 publications

(36 citation statements)

References 40 publications

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“…Not surprisingly, patients with gout and diabetes had higher HRs of MI than those with only diabetes (HR 1.35, 95% CI 1.25–1.47) and those without gout or diabetes (HR 2.55, 95% CI 2.35–2.77). Thus, our study confirms previous findings that gout is an independent risk factor for MI [ 2 – 8 , 26 ] and shows that MI risk with gout was additive to the higher risk noted with diabetes. This finding highlights the difference in being a risk factor vs. a risk equivalent to diabetes.…”

Section: Discussionsupporting

confidence: 92%

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Singh

Ramachandaran

et al. 2017

Arthritis Res Ther

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BackgroundGout is a risk factor for cardiovascular disease, but associations with specific cardiovascular outcomes, myocardial infarction (MI), and stroke are unclear. Our objective in the present study was to assess whether gout is as strong a risk factor as diabetes mellitus (DM) for incident MI and incident stroke.MethodsIn this retrospective study, we used U.S. claims data from 2007 to 2010 that included a mix of private and public health plans. Four mutually exclusive cohorts were identified: (1) DM only, (2) gout only, (3) gout and DM, and (4) neither gout nor DM. Outcomes were acute MI or stroke with hospitalization. We compared the age- and sex-specific rates of incident MI and stroke across the four cohorts and assessed multivariable-adjusted HRs.ResultsIn this study, 232,592 patients had DM, 71,755 had gout, 23,261 had both, and 1,010,893 had neither. The incidence of acute MI was lowest in patients with neither gout nor DM, followed by patients with gout alone, DM alone, and both. Among men >80 years of age, the respective rates/1000 person-years were 14.6, 25.4, 27.7, and 37.4. Similar trends were noted for stroke and in women. Compared with DM only, gout was associated with a significantly lower adjusted HR of incident MI (HR 0.81, 95% CI 0.76–0.87) but a similar risk of stroke (HR 1.02, 95% CI 0.95–1.10). Compared with patients with DM only, patients with both gout and DM had higher HRs for incident MI and stroke (respectively, HR 1.35, 95% CI 1.25–1.47; HR 1.42, 95% CI 1.29–1.56).ConclusionsGout is a risk equivalent to DM for incident stroke but not for incident MI. Having both gout and DM confers incremental risk compared with DM alone for both incident MI and stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1427-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Singh

Ramachandaran

et al. 2017

Arthritis Res Ther

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“…We performed a retrospective analysis on an inception cohort in the Rheumatology Unit of the Hospital General Universitario de Alicante (Spain). The characteristics of the cohort have been described elsewhere [ 12 ]. Briefly, recruited patients are those presenting to the unit for the first time with crystal-proven gout without having received previous specialised care.…”

Section: Methodsmentioning

confidence: 99%

Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort

et al. 2018

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BackgroundDiuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. MethodsThis was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis.ResultsWe included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = − 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = − 0.47, p = 0.833). There was no association with febuxostat (beta = − 0.116, p = 0.514).ConclusionDiuretics do not appear to have a significant impact on managing gout.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1559-2) contains supplementary material, which is available to authorized users.

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“…Andrеs и соавт. [40] при оценке 237 пациентов с подагрой по шкалам SCORE и FHS (Фрамингемская шкала) выявили высокий риск ССЗ в 40% случаев. В нашей группе пациентов с БДПК высокий риск встречался чаще, несмотря на несколько меньший, чем у пациентов с подагрой, средний возраст (60,7 и 63,7 года соответственно).…”

Section: Discussionunclassified

“…В работе M. Andres и соавт. атеросклеротическое поражение при сонографии сонных артерий определялось у половины пациентов с подагрой, имеющих низкое значение индекса SCORE, что позволяет говорить об участии в генезе ССЗ других, «нетрадиционных» ФР, прежде всего хронического иммунного воспаления [40].…”

Section: Discussionunclassified

Cardiovascular risk factors in patients with calcium pyrophosphate crystal deposition disease

Елисеев¹,

Желябина²,

Чикина³

et al. 2019

Naučno-praktičeskaâ revmatologiâ

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Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment

Abstract: The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout.

Cited by 43 publications

References 40 publications

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Is gout a risk equivalent to diabetes for stroke and myocardial infarction? A retrospective claims database study

Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort

Cardiovascular risk factors in patients with calcium pyrophosphate crystal deposition disease

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