I. Calabuig 1, M. Gómez-Garberí 2, M. Andrés 1,2
1 Hospital General Universitario de Alicante-Isabial, Sección de Reumatología; ² Universidad Miguel Hernández
Background: Gout is an independent risk factor for cardiovascular diseases (CVDs), where the urate crystal-led inflammatory state likely has a key role. Crystal dissolution may carry with cardiovascular benefits, so optimal management of gout patients is essential, especially in high-risk individuals, such as those hospitalised for CVDs. Although the prevalence of gout in Western country adults is about 2-4% [Kuo, Nat Rev Rheum 2015], the rate and characteristics in inpatients with CVDs remains to be defined.
Objectives: To determine the prevalence of gout, characteristics and management in a hospitalised population for CVDs.
Methods: Observational, descriptive, cross-sectional study. Patients admitted for CVDs in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre were recruited following a non-consecutive, systematic sampling up to reaching the estimated minimum sample size. A face-to-face interview and a review of electronic health records were performed, in order to collect clinical, laboratory and management data regarding CVD and gout. Gout diagnosis was established in the interview using ACR/EULAR 2015 criteria. In addition, prior clinical or crystal-proven diagnoses at records were also registered. 95% confidence intervals (95%CI) were calculated for primary variable (gout prevalence), and comparisons were performed by Student’s t, chi-squared and Fisher’s exact tests.
Results: 299 patients were interviewed, 33 were excluded, and the final study sample was 266 participants. They were predominantly males (69.9%) and Caucasians (96.6%) with a mean age of 68 years (SD±12). The CVDs leading to admission were acute coronary syndrome (18.8%; n=50), heart failure (13.2%; n=35), stroke or transient ischemic attack (20.7%; n=55) and peripheral artery disease (47.4%; n=126). Gout was identified in 40 individuals (prevalence 15.0%; 95%CI 10.9-19.2). Prior gout diagnosis was found in 65.0% (n=26) [clinical in 20 (50.0%), crystal-proven in 6 (15.0%)], while in the remaining [n=14, 35.0%] gout was diagnosed at the interview. Patients with gout were older (72±9 vs 68±13 years, p=0.026) and showed higher rates of chronic kidney disease (55.0% vs 23.0%, p<0.001) and use of diuretics (55.0% vs 38.5%, p=0.05), with no differences in other variables. Gout showed a median (IQR) duration of 15 (10-30), 3 flares (1-9) and 2 involved joints (1-3). Tophi were seen in 7.7% of the patients. The serum urate levels at the time of the CVD were 7.1±2.6 mg/dl and only 8 patients (33.3%) were on target (<6mg/dl). Despite 70.0% of patients (n=28) having been treated with urate-lowering agents at some point, at admission only 50.0% (n=20) were currently taken (38.5% of them on target). Nearly a quarter of patients (23.8%, n=5) used prophylactic colchicine.
Conclusion: Gout is prevalent in hospitalised patients for CVDs, affecting one in seven cases. The management of gout in these patients appears suboptimal, with serum uric acid levels above recommended targets and a significant percentage of no urate-lowering treatment.