MADRID – Optimizing anti-inflammatory treatment may help to reduce the risk of heart-related problems in men with crystal-proven gout, judging from 7-year follow up data from a prospective study.
Five factors were found to increase substantially the risk for cardiovascular (CV) events in the 251-patient study: including: high levels of C-reactive protein (CRP); renal insufficiency; daily intake of more than 20 g of alcohol; current coronary heart disease (CHD); and a family history of premature CV events.
The odds ratio (OR) for any CV event was 5.71 for CRP levels greater than 5 mg/L on multivariate analysis. This increased to 10.31 and 14.26 when nonfatal and fatal CV events were considered separately.
Odds ratios for renal insufficiency, defined as a creatinine clearance of less than 60 mL/min per 1.73 m2, were 4.76 for any CV event and 8.42 for fatal CV events. Respective values for a family history of CV events before the age of 55 years was 3.09 considering any CV event, but 7.53 if consideration was limited to fatal events only. Current CHD also increased the risk for any CV event (OR, 3.67) and for nonfatal events (OR, 10.41).
Alcohol intake of more than 20g/day carried an OR of 4.23 for any CV event.
"We have a cardiologist in our team to ensure the reliability of the cardiovascular outcomes," said Dr. Victoria Barskova of the Research Institute of Rheumatology in Moscow, who presented the findings at the annual European Congress of Rheumatology (Ann. Rheum. Dis. 2013;72[suppl. 3]:95). She explained that the study was designed to prospectively determine baseline factors that might influence the development of CV events in male patients with crystal-proven gout.
Between 2003 and 2006, a total of 407 men were screened and 301 deemed eligible for the study. Of these, 251 had follow-up data to 2010-2012. Data collected at baseline and at follow-up included patient demographics, including family history of gout and early CV disease, smoking history, and alcohol consumption. Comorbidities and gout characteristics were also assessed and all patients had an ECG and echocardiogram.
Comparing baseline clinical features with follow-up visit data, Dr. Barskova noted that the number of allopurinol users increased from 16% to 57% (P = .00001), although regular allopurinol use was not found to decrease the risk for CV events.
There was an increase in the percentage of patients with diabetes from 18% to 43% (P = .00001), chronic heart disease from 35% to 53% (P = .00001), and heart failure from 10% to 28% (P = .0001). Alcohol use significantly decreased (92% vs. 63%; P less than .0001).
The frequency of subcutaneous tophi and chronic arthritis comparing the first and last visits was the same.
Just under a quarter (23.1%, n = 58) of patients experienced a CV event. There were 32 (13%) deaths reported of which 22 were from cardiovascular causes. There were 36 nonfatal CV events.
"In our cohort of patients with crystal proven gout, the following independent risk factors for all CV events have been highlighted: CRP, renal insufficiency, alcohol intake, coronary heart disease, and a family history of CV events," Dr. Barskova said in conclusion.
The key message for rheumatologists, she added, is that "tight control of inflammation, which is measured not only by the obvious arthritis, but also by the serum CRP level, may have a positive effect on cardiovascular events in patients with gout."