Evaluate CV Risk in Tophaceous Gout

November 11, 2015

Maintaining normal serum urate concentrations can prevent tophi formation in gout reducing cardiovascular risk factors.

What’s the cardiovascular risk for those with different stages of gout? In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Rada Gancheva of the University Hospital St. Ivan Rilski’s Clinic of Rheumatology, Bulgaria, presented new data on cardiovascular risk associated with gouty tophi. The presence of gouty tophi is an independent and possibly stronger risk factor than arterial hypertension for cardiovascular risk. In a study of 170 patients, Gancheva found that patients with gouty tophi had an increased likelihood of having an abnormal common carotid artery resistive index. “Gouty tophi are very important in the monitoring of disease,” he said in an interview. “In terms of cardiovascular risk, the presence of tophi is an indicator of its increase.”  The patients were divided into four groups:  control group (n=35) with osteoarthritis and conventional cardiovascular disease cardiovascular risk factors; a group with asymptomatic hyperuricemia (n=41); a group with gout patients without tophi (n=52) and, patients with gouty tophi (n=42). Of patients with conventional cardiovascular risk factors, researchers showed an association between smoking (p=0.044), dyslipidemia (p=0.006) and the examined groups of diseases. There was no significant difference in the incidence of arterial hypertension (p=0.148), diabetes mellitus (p=0.343), obesity (p=0.539) and reduced eGFR (p=0.145) between the four groups.  Researchers found that gout without tophi raised the risk of having thicker intima-media with an OR=6.245 (95% CI; 1.371 – 28.443, p=0.018). They found that gouty tophi markedly raised the risk with an OR=11.509 (95% CI; 2.315 – 57.213, p=0.003), but asymptomatic hyperuricemia did not significantly modify the odds of having abnormal IMT.  Arterial hypertension was found to increase the risk of having abnormally high CCARI with an OR=3.217 (95% CI; 1.105 – 9.363, p=0.032). The presence of tophi raised the risk with an OR=11.179 (95% CI; 2.613 – 47.825, p=0.001), while asymptomatic hyperuricemia and gout without tophi did not significantly change the risk of having higher CCARI.  The study has implications for treating patients. “Rheumatologists and other clinicians who care for patients with gout should optimize treatment to maintain normal serum urate concentration, and in this way, prevent the formation of tophi,” Gancheva said. “When tophi are present, cardiovascular risk should be evaluated, chronic inflammatory process suppressed and cardiovascular risk factors aggressively managed.”  

References:

ACR 2015 abstract title:

How Strong Cardiovascular Risk Factor Are Gouty Tophi?

Presenter, Rada Gancheva.  Nov. 10, 2015