Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Calabuig, Irene; Martínez-Sanchis, A.; Andrés, Mariano

doi:10.3389/fmed.2021.795984

Cited by 13 publications

(15 citation statements)

References 47 publications

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“…Tophaceous gout is recognized as a leading cardiovascular predictor, 29,33 and patients with oligoarticular or polyarticular presentation, higher SU levels, and longer disease duration also suffer from CVEs more frequently 29,34 . Although our results could not confirm this impact in a population with cardiovascular disease—probably due to the small number and varying disease stages of included patients—these associations are indicative of the negative impact of large MSU crystal burdens and their subsequent persistent inflammation, as recently confirmed by data using dual-energy computed tomography 35 and ultrasound 36 . Serum urate normalization leads to crystal depletion, so European League Against Rheumatism experts recommend prompt ULT for patients with larger crystal burden and/or established cardiovascular disease 37 .…”

Section: Discussioncontrasting

confidence: 51%

“…29,34 Although our results could not confirm this impact in a population with cardiovascular diseaseprobably due to the small number and varying disease stages of included patients-these associations are indicative of the negative impact of large MSU crystal burdens and their subsequent persistent inflammation, as recently confirmed by data using dual-energy computed tomography 35 and ultrasound. 36 Serum urate normalization leads to crystal depletion, so European League Against Rheumatism experts recommend prompt ULT for patients with larger crystal burden and/or established cardiovascular disease. 37 As lower SU levels are associated with faster tophi disap-pearance and effective crystal dissolution, it is likely that these patients would also benefit from rigid SU targets.…”

Section: Discussionmentioning

confidence: 99%

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Gout Screening Identifies a Large Cardiovascular Population at Increased Risk of Mortality

et al. 2022

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Objective: Gout is prevalent in people with cardiovascular disease, although up to a third of the cases remain unregistered. We aimed to assess whether active gout screening in inpatients with cardiovascular events helps identify patients at higher risk of mortality after discharge.Methods: This study included patients admitted for cardiovascular events. Gout was established by records review and clinical interview. After discharge, electronic medical records were reviewed for mortality and cause of death. The association between gout and subsequent mortality was tested using Cox regression models.Results: Of 266 recruited patients, 17 were lost to follow-up, leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5%) were classified as having gout; 13 of these (36.1%) were identified through the interview. Mean follow-up was 19.9 (SD, 8.6) months. Gout significantly increased the risk of all-cause mortality in the overall sample (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.13-3.58) and in the subgroup with a prior diagnosis of gout (HR, 2.89; 95% CI, 1.54-5.41). The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI, 1.01-3.41). Patients with gout carried an increased risk of both cardiovascular and noncardiovascular deaths; age and chronic kidney disease were mortality predictors within the gout population. Conclusion:Gout was an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed the detection of a larger population at high risk of mortality and could help tailor patient management to minimize the cardiovascular impact.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Gout Screening Identifies a Large Cardiovascular Population at Increased Risk of Mortality

et al. 2022

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“…1 Evidence describes associations between gout and cardiovascular disease. [2][3][4] High urate levels and presence of subcutaneous tophi have both been associated with an increased risk of mortality in patients with gout, and it was suggested that total body urate load could be a plausible pathophysiological link between gout and cardiovascular disease. 5 The volume of crystal deposition measured with dual-energy CT (DECT) has been found to be a biomarker for the risk of developing new cardiometabolic diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Gout is caused by deposition of monosodium urate (MSU) crystals in joints and/or extra-articular tissues and gout has increased in incidence the last decades 1. Evidence describes associations between gout and cardiovascular disease 2–4. High urate levels and presence of subcutaneous tophi have both been associated with an increased risk of mortality in patients with gout, and it was suggested that total body urate load could be a plausible pathophysiological link between gout and cardiovascular disease 5.…”

Section: Introductionmentioning

confidence: 99%

Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study

et al. 2022

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BackgroundGout is of unknown reason associated with cardiovascular disease. Ultrasound is sensitive for detecting crystal deposition and plasma calprotectin is a sensitive inflammatory marker. This study explores the associations between crystal deposition, inflammation and carotid artery pathology.MethodA cross-sectional analysis of baseline assessments from the NOR-Gout study was undertaken. Crystal deposition was assessed by ultrasound (double contour, tophi, aggregates) and dual-energy CT (DECT) and laboratory assessments included plasma calprotectin. The carotid arteries were bilaterally examined for carotid intima–media thickness (cIMT) and presence of plaques. Spearman correlations, Mann-Whitney tests and linear regression analyses were used to explore associations between crystal deposition, inflammatory markers,and carotid pathology.Results202 patients with intercritical gout (95.5% men, mean (SD) age 56.5 (13.8) years, disease duration 7.9 (7.7) years) were included. Calprotectin was correlated with all scores of crystal deposition by ultrasound (r=0.26–0.32, p<0.001) and DECT (r=0.15, p<0.05). cIMT was correlated with sum score aggregates (r=0.18–0.22, p<0.05). Patients with large tophi had higher levels of calprotectin as well as more frequent carotid plaque (p<0.05).ConclusionsStudy findings point towards crystal deposition contributing to subclinical inflammation with subsequent vascular implications. However, future longitudinal studies are needed to confirm such causal relationships.

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“…A prospective 5-year follow-up study confirmed that the presence of carotid plaques predicted the development of cardiovascular events and death in patients with RA ( 39 ). A recent study showed that the presence of tophi and a positive power Doppler signal were significantly associated with atheroma plaques in 103 Spanish gout patients ( 40 ). Also, the increased IMT measurement showed no association with MSU crystal, which is similar to our study.…”

Section: Discussionmentioning

confidence: 99%

Presence of tophi and carotid plaque were risk factors of MACE in subclinical artherosclerosis patients with gout: a longitudinal cohort study

et al. 2023

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BackgroundPatients with gout carry an excess risk for cardiovascular disease (CVD), but the contribution of subclinical atherosclerosis to the CVD risk has never been reported. In this study, we aimed to explore the predictive factors for incident major adverse cardiovascular events (MACE) in gout patients without a previous history of CVD or cerebral vascular disease.MethodsA single-center, long-term follow-up cohort analysis was performed to assess subclinical atherosclerosis at baseline since 2008. Patients with a previous history of CVD or cerebrovascular disease were excluded. The outcome of the study was the first MACE. The presence of subclinical atherosclerosis was assessed by carotid plaque (CP), and carotid intima-media thickness (CMIT) was determined by ultrasound. An ultrasound scan of bilateral feet and ankles was performed at baseline. The association between tophi, carotid atherosclerosis, and the risk of developing incident MACE was evaluated using Cox proportional hazards models with adjustment for the CVD risk scores.ResultsA total of 240 consecutive patients with primary gout were recruited. Their mean age was 44.0 years, with male predominance (238, 99.2%). During a median follow-up of 10.3 years, incident MACE was ascertained in 28 (11.7%) patients. In a Cox hazards model, controlling for the CV risk scores, the presence of at least two tophi (HR, 2.12–5.25, p < 0.05) and carotid plaque (HR, 3.72–4.01, p < 0.05) were identified as independent predictors of incident MACE in gout patients.ConclusionsThe presence of at least two tophi and carotid plaque on an ultrasound could independently predict MACE in addition to conventional cardiovascular risk factors in gout patients.

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Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

Cited by 13 publications

References 47 publications

Gout Screening Identifies a Large Cardiovascular Population at Increased Risk of Mortality

Gout Screening Identifies a Large Cardiovascular Population at Increased Risk of Mortality

Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study

Presence of tophi and carotid plaque were risk factors of MACE in subclinical artherosclerosis patients with gout: a longitudinal cohort study

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