Independent risk factors for severe cardiovascular events in male patients with gout: Results of a 7-year prospective study


Cite item

Full Text

Abstract

Aim. To determine risk factors for severe cardiovascular (CV) events (CVEs) in male patients with crystal-verified gout. Subjects and methods. 251 male patients with crystal-verified gout were prospectively followed up in 2003 to 2013. The mean follow-up period was 6.9±2.0 years. New severe CVE cases and deaths were recorded. Logistic regression was used to analyze the impact of traditional and other risk factors and allopurinol use on the risk for severe CVEs. Results. 32 patients died during the follow-up period. Severe CVEs were recorded in 58 (23.1%) patients; CVE deaths were notified in 22 (8.8%) patients. The risk of all severe CVEs was high for hypertension, increased serum high-sensitivity C-reactive protein (hs-CRP) level (>5 mg/l), ≥ stage III chronic kidney disease (CKD) (glomerular filtration rate, <60 ml/min/1.73 m2), alcohol intake (>20 g/day), coronary heart disease (CHD), and a family history of premature CHD. The risk of fatal CVEs was highest for elevated serum hs-CRP level, ≥stage III CKD, a family history of premature CHD, hypercholesterolemia, upper quartile of serum uric acid levels (>552 µmol/l), and regular intake of allopurinol. Conclusion. In addition to the traditional risk factors of CV catastrophes, the presence of chronic inflammation and the impact of high serum uric acid levels may explain the high frequency of CV catastrophes.

About the authors

M S Eliseev

ФГБНУ «НИИ ревматологии им. В.А. Насоновой»

Москва, Россия

I S Denisov

ФГБНУ «НИИ ревматологии им. В.А. Насоновой»

Москва, Россия

E I Markelova

ФГБНУ «НИИ ревматологии им. В.А. Насоновой»

Москва, Россия

S I Glukhova

ФГБНУ «НИИ ревматологии им. В.А. Насоновой»

Москва, Россия

E L Nasonov

ФГБНУ «НИИ ревматологии им. В.А. Насоновой»; ГБОУ ВО «Первый МГМУ им. И.Н. Сеченова» Минздрава России

Москва, Россия

References

  1. Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010;12(6):223. doi: 10.1186/ar3199
  2. Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74(4):661-667. doi: 10.1136/annrheumdis-2013-204463
  3. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-3141. doi: 10.1002/art.30520
  4. Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation. 2007;116(8):894-900.
  5. Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH.; MRFIT Research Group. Long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med. 2008;168(10):1104-1110. doi: 10.1001/archinte.168.10.1104
  6. Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, Lin CM, Chen HW, Yu KH. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2010; 49 (1):141-146. doi: 10.1093/rheumatology/kep364
  7. Perez-Ruiz F, Martínez-Indart L, Carmona L, Herrero-Beites AM, Pijoan JI, Krishnan E. Tophaceous gout and high level of hyperuricaemia are both associated with increased risk of mortality in patients with gout. Ann Rheum Dis. 2014;73(1):177-182. doi: 10.1136/annrheumdis-2012-202421
  8. Kuo CF, Yu KH, See LC. et al. Risk of myocardial infarction among patients with gout: a nationwide population-based study. Rheumatology (Oxford). 2013;52(1):111-117. doi: 10.1093/rheumatology/kes169
  9. Seminog OO, Goldacre MJ. Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies. Rheumatology (Oxford). 2013;52(12):2251-2259. doi: 10.1093/rheumatology/ket293
  10. Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open. 2012;2(1):e000282. doi: 10.1136/bmjopen-2011-000282
  11. Krishnan E, Akhras KS, Sharma H, Marynchenko M, Wu E, Tawk RH, Liu J, Shi L. Serum urate and incidence of kidney disease among veterans with gout. J Rheumatol. 2013;40(7): 1166-1172. doi: 10.3899/jrheum.121061
  12. Krishnan E, Pandya BJ, Lingala B, Hariri A, Dabbous O. Hyperuricemia and untreated gout are poor prognostic markers among those with a recent acute myocardial infarction. Arthritis Res Ther. 2012;14(1):R10. doi: 10.1186/ar3684
  13. Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke. 2003;34(8):1951-196.
  14. Karagiannis A, Mikhailidis DP, Tziomalos K, Sileli M, Savvatianos S, Kakafika A, Gossios T, Krikis N, Moschou I, Xochellis M, Athyros VG. Serum uric acid as an independent predictor of early death after acute stroke. Circ J. 2007;71(7):1120-1127.
  15. Thanassoulis G, Brophy JM, Richard H, Pilote L. Gout, allopurinol use, and heart failure outcomes. Arch Intern Med. 2010;170(15):1358-1364. doi: 10.1001/archinternmed.2010.198
  16. Krishnan E, Baker JF, Furst DE, Schumacher HR. Gout and the risk of acute myocardial infarction. Arthritis Rheum. 2006; 54(8):2688-2696.
  17. Liu KL, Lee HF, Chou SH, Lin YC, Lin CP, Wang CL, Chang CJ, Hsu LA. Acute gouty arthritis complicated with acute ST elevation myocardial infarction is independently associated with short- and long-term adverse non-fatal cardiac events. Clin Rheumatol. 2014;33(1):91-98. doi: 10.1007/s10067-013-2376-2
  18. Pascual E. Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout. Arthritis Rheum. 1991;34(2):141-145.
  19. Chen CJ, Shi Y, Hearn A, Fitzgerald K, Golenbock D, Reed G, Akira S, Rock KL. MyD88-dependent IL-1 receptor signaling is essential for gouty inflammation stimulated by monosodium urate crystals. J Clin Invest. 2006;116(8):2262-2271.
  20. Stamp LK, Turner R, Khalilova IS, Zhang M, Drake J, Forbes LV, Kettle AJ. Myeloperoxidase and oxidation of uric acid in gout: implications for the clinical consequences of hyperuricaemia. Rheumatology (Oxford). 2014;53(11):1958-1965. doi: 10.1093/rheumatology/keu218
  21. Nicholls SJ, Hazen SL. Myeloperoxidase and cardiovascular disease. Arterioscler Thromb Vasc Biol. 2005;25(6):1102-1111.
  22. Heslop CL, Frohlich JJ, Hill JS. Myeloperoxidase and C-reactive protein have combined utility for long-term prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol. 2010;55(11):1102-1109. doi: 10.1016/j.jacc.2009.11.050
  23. Erdogan D, Gullu H, Caliskan M, Yildirim E, Bilgi M, Ulus T, Sezgin N, Muderrisoglu H. Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults. Int J Clin Pract. 2005;59(11):1276-1282.
  24. Karbowska A, Boratynska M, Kusztal M, Klinger M. Hyperuricemia is a mediator of endothelial dysfunction and inflammation in renal allograft recipients. Transplant Proc. 2009;41(8):3052-3055. doi: 10.1016/j.transproceed.2009.07.080
  25. Neogi T, George J, Rekhraj S, Struthers AD, Choi H, Terkeltaub RA. Are either or both hyperuricemia and xanthine oxidase directly toxic to the vasculature? A critical appraisal. Arthritis Rheum. 2012;64(2):327-338. doi: 10.1002/art.33369
  26. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Volume 1-3. Russian edition. Medicine. The World Health Organization, Geneva. 1995.
  27. World Health Organization: International Statistical Classification of Diseases and Related Health Problems 10th Revision, Version for 2010. Geneva: World Health Organization. Accessed Jun 2011. http://apps.who.int/classifications/ apps/isd/isd/10online/
  28. Kuo CF, Yu KH, See LC, Chou IJ, Tseng WY, Chang HC, Shen YM, Luo SF. Elevated risk of mortality among gout patients: a comparison with the national population in Taiwan. Joint Bone Spine. 2011;78(6):577-580. doi: 10.1016/j.jbspin.2011.01.007
  29. Stack AG, Hanley A, Casserly LF, Cronin CJ, Abdalla AA, Kiernan TJ, Murthy BV, Hegarty A, Hannigan A, Nguyen HT. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM. 2013;106(7):647-658. doi: 10.1093/qjmed/hct083
  30. Clarson LE, Chandratre P, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015;22(3):335-343. doi: 10.1177/2047487313514895
  31. Rock KL, Kataoka H, Lai JJ. Uric acid as a danger signal in gout and its comorbidities. Nat Rev Rheumatol. 2013;9(1):13-23. doi: 10.1038/nrrheum.2012.143
  32. Krishnan E, Pandya BJ, Chung L, Dabbous O. Hyperuricemia and the risk for subclinical coronary atherosclerosis--data from a prospective observational cohort study. Arthritis Res Ther. 2011;13(2):R66. doi: 10.1186/ar3322
  33. Sundström J, Sullivan L, D’Agostino RB, Levy D, Kannel WB, Vasan RS. Relations of serum uric acid to longitudinal blood pressure tracking and hypertension incidence. Hypertension. 2005;45(1):28-33.
  34. Mellen PB, Bleyer AJ, Erlinger TP, Evans GW, Nieto FJ, Wagenknecht LE, Wofford MR, Herrington DM. Serum uric acid predicts incident hypertension in a biethnic cohort: the atherosclerosis risk in communities study. Hypertension. 2006;48(6):1037-1042.
  35. Tavil Y, Kaya MG, Oktar SO, Sen N, Okyay K, Yazici HU, Cengel A. Uric acid level and its association with carotid intima-media thickness in patients with hypertension. Atherosclerosis. 2008; 197(1):159-163.
  36. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-1821. doi: 10.1056/NEJMra0800885
  37. Wheeler JG, Juzwishin KD, Eiriksdottir G, Gudnason V, Danesh J. Serum uric acid and coronary heart disease in 9,458 incident cases and 155,084 controls: prospective study and meta-analysis. PLoS Med. 2005;2(3):e76.
  38. Strazzullo P, Puig JG. Uric acid and oxidative stress: relative impact on cardiovascular risk? Nutr Metab Cardiovasc Dis. 2007;17(6):409-414.
  39. Kaufman M, Guglin M. Uric acid in heart failure: a biomarker or therapeutic target? Heart Fail Rev. 2013;18(2):177-186. doi: 10.1007/s10741-012-9322-2
  40. George J, Carr E, Davies J, Belch JJ, Struthers A. High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation. 2006;114(23):2508-2516.
  41. Wei L, Mackenzie IS, Chen Y, Struthers AD, MacDonald TM. Impact of allopurinol use on urate concentration and cardiovascular outcome. Br J Clin Pharmacol. 2011;71(4):600-607. doi: 10.1111/j.1365-2125.2010.03887.x
  42. Beattie CJ, Fulton RL, Higgins P, Padmanabhan S, McCallum L, Walters MR, Dominiczak AF, Touyz RM, Dawson J. Allopurinol initiation and change in blood pressure in older adults with hypertension. Hypertension. 2014;64(5):1102-1107. doi: 10.1161/HYPERTENSIONAHA.114.03953
  43. Dubreuil M, Zhu Y, Zhang Y, Seeger JD, Lu N, Rho YH, Choi HK. Allopurinol initiation and all-cause mortality in the general population. Ann Rheum Dis. 2015;74(7):1368-1372. doi: 10.1136/annrheumdis-2014-205269
  44. Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R, Danesh J. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010;375(9709):132-140. doi: 10.1016/S0140-6736(09)61717-7
  45. Braunwald E. Creating controversy where none exists: the important role of C-reactive protein in the CARE, AFCAPS/TexCAPS, PROVE IT, REVERSAL, A to Z, JUPITER, HEART PROTECTION, and ASCOT trials. Eur Heart J. 2012;33(4):430-432. doi: 10.1093/eurheartj/ehr310
  46. Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, McInnes IB, Haentzschel H, Gonzalez-Gay MA, Provan S,Semb A, Sidiropoulos P, Kitas G, Smulders YM, Soubrier M, Szekanecz Z, Sattar N, Nurmohamed MT. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69(2):325-331. doi: 10.1136/ard.2009.113696
  47. Carter JD, Patelli M, Anderson SR, Prakash N, Rodriquez EJ, Bateman H, Sterrett A, Valeriano J, Ricca LR. An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels. Clin Rheumatol. 2015;34(2):345-351. doi: 10.1007/s10067-014-2644-9
  48. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13(1):R4. doi: 10.1186/ar3223
  49. De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martín-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis. 2012;71(1): 157-158. doi: 10.1136/ard.2011.154997
  50. Chowalloor P, Cheah P, Keen HI. Subclinical Synovial Inflammation in Gout. Arthritis & Rheumatology. ACR 2014;66(11)(Suppl.):S64.
  51. Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol. 2009;15(1):22-24. doi: 10.1097/RHU.0b013e3181945b79

Copyright (c) 2017 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies