Gout Is Associated With Increased Coronary Artery Calcification and Adverse Cardiovascular Outcomes

Christensen, Jared; Yu, Wenzheng; Tan, Sydney; Chu, Alice; León-Vargas, Fabián; Assali, Maen; Shah, Nishant; Wu, Wen‐Chih; Choudhary, Gaurav; Morrison, Alan

doi:10.1016/j.jcmg.2019.10.019

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…The Agatston score detects plaque with a CT density greater than 130 HU, and hence also those potentially containing MSU crystals. In line with our study, Christensen et al 28 found in a single-center, retrospective analysis of 1033 veterans that gout was associated with major adverse cardiac events and higher CACS. However, this study is limited by selection biases: older veterans and White men only with significant smoking histories were included.…”

Section: Discussionsupporting

confidence: 93%

“…However, this study is limited by selection biases: older veterans and White men only with significant smoking histories were included. The authors 28 conclude as well that “additional studies are required to assess the mechanistic relationship among uric acid, gouty inflammation, and calcific atherosclerosis leading to increased events in this population, and whether this population would derive particular benefit from more aggressive gout- or inflammation-targeted strategies for reduction of cardiovascular events.”…”

Section: Discussionmentioning

confidence: 99%

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Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study

Feuchtner¹,

Plank²,

Beyer³

et al. 2021

J Comput Assist Tomogr

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ObjectiveMonosodium uric acid (MSU) crystals may accumulate in the coronary plaque. The objective was to assess whether dual-energy computed tomography (DECT) allows for detection of MSU in coronary plaque.MethodsPatients were examined with 128-slice DECT applying a cardiac electrocardiogram-gated and peripheral extremity protocol. Patients were divided into 3 groups: gout (tophi >1 cm in peripheral joints), hyperuricemia (>6.5 mg/dL serum uric acid), and controls. The groups were matched for cardiovascular risk factors. Monosodium uric acid–positive (+) and calcified plaque were distinguished, and the coronary artery calcium score was calculated. Ex vivo phantom: MSU solutions were diluted in different NaCL solutions (5%/10%/15%/20%/25%). Coronary artery models with 2 different plaque types (MSU+ and calcified) were created.ResultsA total of 96 patients were included (37 with gout, 33 with hyperuricemia, and 26 controls). Monosodium uric acid–positive plaques were found more often in patients with gout as compared with controls (91.9% vs 0.38%; P < 0.0001), and the number of plaques was higher (P < 0.0001). Of 102 MSU+ plaques, 26.7% were only MSU+ and 74.2% were mixed MSU+/calcified. Monosodium uric acid–positive plaque had mean 232.3 Hounsfield units (range, 213–264). Coronary artery calcium score was higher in patients with gout as compared with controls (659.1 vs 112.4 Agatston score; P < 0.001). Patients with gout had more MSU+ plaques as compared with patients with hyperuricemia (91.6% vs 2.9%; P < 0.0001), and coronary artery calcium score was higher (659.1 vs 254 Agatston score; P < 0.001), but there was no difference between patients with hyperuricemia and controls. Ex vivo phantom study: MSU crystals were detected by DECT in solutions with a concentration of 15% or greater MSU and could be distinguished from calcified.ConclusionsCoronary MSU+ plaques can be detected by DECT in patients with gout.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study

Feuchtner¹,

Plank²,

Beyer³

et al. 2021

J Comput Assist Tomogr

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“…We also found that despite similar demographic characteristics and kidney function, gout patients had a higher prevalence of ischemic heart disease and congestive heart failure. These findings are consistent with general population studies showing independent associations between gout and cardiovascular disease [11,16], including coronary artery disease [3,17], coronary artery calcification (CAC) severity [18], and heart failure [11,19]. Because all included patients in the current study had CKD, a well-known risk factor for cardiovascular disease [20], our findings suggest that gout may impose added risk on CKD patients.…”

Section: Discussionsupporting

confidence: 90%

Prevalence and Influence of Gout in Patients with Advanced Chronic Kidney Disease: Findings of a Large Retrospective Chart Review

Stern,

Johnson,

Shakouri

et al. 2024

GUCDD

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Gout patients have higher mortality, heavier comorbidity burden, and lower quality of life than non-gout patients, but information is sparse on how gout affects advanced CKD patients. This study examined the prevalence and potential health impacts in stage 3–5 CKD patients. Gout was defined as being listed as a comorbidity, ULT use, and/or reported gout symptoms (tophi, >1 flare). Uncontrolled gout was defined as hyperuricemia (serum urate >6 mg/dL) with tophi, ≥2 gout flares/year, or ≥1 swollen/tender joint. This study included 746 patients (55% men, age: 56.2 ± 18.3 years, CKD-duration: 4.0 ± 4.8 years, eGFR: 32.2 ± 15.5 mL/min/1.73 m2), of which 23% met the gout criteria. Prevalence was highest in patients with stage 3b and 4 CKD. Gout patients had a significantly higher prevalence of cardiovascular comorbidities, CKD-mineral bone disorder, and back pain than non-gout patients. Uncontrolled gout patients had more hypertension, joint issues, chronic pain, febuxostat use, and colchicine use than controlled patients. Compared to those without gout, gout patients had higher rates of cardiovascular and bone diseases, with uncontrolled patients having an even higher burden. In conclusion, these data suggest that identifying and monitoring gout in CKD patients provides health benefits. However, more than one-third of gout patients did not have a formal gout diagnosis in their medical record.

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“…The past several decades have seen a surge in gout prevalence, along with associated increases in functional impairment and diminished health-related quality of life [2]. Epidemiological evidence suggests an association between gout and cardiovascular disease [3,4]. In addition to increased rates of traditional cardiovascular risk factors in patients with gout [5,6], gout conveys an independent risk for adverse cardiovascular outcomes [7,8].…”

Section: Introductionmentioning

confidence: 99%

Initiating guideline-concordant gout treatment improves arterial endothelial function and reduces intercritical inflammation: a prospective observational study

Toprover

Shah

et al. 2020

Arthritis Res Ther

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Background: Patients with gout have arterial dysfunction and systemic inflammation, even during intercritical episodes, which may be markers of future adverse cardiovascular outcomes. We conducted a prospective observational study to assess whether initiating guideline-concordant gout therapy with colchicine and a uratelowering xanthine oxidase inhibitor (XOI) improves arterial function and reduces inflammation. Methods: Thirty-eight untreated gout patients meeting American College of Rheumatology (ACR)/European League Against Rheumatism classification criteria for gout and ACR guidelines for initiating urate-lowering therapy (ULT) received colchicine (0.6 mg twice daily, or once daily for tolerance) and an XOI (allopurinol or febuxostat) titrated to ACR guideline-defined serum urate (sU) target. Treatment was begun during intercritical periods. The initiation of colchicine and XOI was staggered to permit assessment of a potential independent effect of colchicine. Brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) assessed endothelium-dependent and endothelium-independent (smooth muscle) arterial responsiveness, respectively. High-sensitivity C-reactive protein (hsCRP), IL-1β, IL-6, myeloperoxidase (MPO) concentrations, and erythrocyte sedimentation rate (ESR) assessed systemic inflammation.

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Gout Is Associated With Increased Coronary Artery Calcification and Adverse Cardiovascular Outcomes

Cited by 5 publications

References 2 publications

Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study

Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study

Prevalence and Influence of Gout in Patients with Advanced Chronic Kidney Disease: Findings of a Large Retrospective Chart Review

Initiating guideline-concordant gout treatment improves arterial endothelial function and reduces intercritical inflammation: a prospective observational study

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