Women With Gout Face Bigger CVD Peril

Mar 12, 2015

Watch especially for cardiovascular risk in women who have gout, warn the authors of an observational study using a large British primary-care database.

Clarson LE, Hider SL, Belcher J, et al.,Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK Clinical Practice Research Datalink. Ann Rheum Dis 2015;74(4):642-647 doi:10.1136/annrheumdis-2014-205252. (Open access)

Gout is more common among men, but women with gout are at greater risk of incident vascular events such as strokes and deep vein thrombosis, according to a retrospective cohort study from the world’s largest database of primary care electronic health records.

British researchers warn that extra vigilance for hyperuricemia is warranted among women, even before they’re diagnosed with gout.

The analysis compares 8,386 gout patients with 39,766 age- and sex-matched controls without gout from the UK Clinical Practice Research Datalink, looking at the risk of coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD) in the 10 years after a diagnosis of gout. 

None of the study participants (almost 70% of whom are men with a median age of 66) had a prior vascular history, but virtually all have other cardiovascular risk factors compared with non-gout patients, with the exception of diabetes.

Those with gout tended to be overweight – more than half with a body mass index (BMI) over 25 – and have more hypertension, elevated cholesterol, and chronic kidney disease.

The absolute risk of any vascular event (per 1,000 person years) was 44.63 for men with gout and 51.89 for women, compared to 33.70 for men and 33.41 for women without gout.

The risk for PVD, which is doubled among women who have gout, is particularly gender-specific.

Additionally, female gout patients are at greater risk of angina, transient ischemic attacks (TIAs), and cardiovascular accidents, men with gout are not.

The reasons for the gender difference are unclear, but the researchers speculate that prolonged exposure to hyperuricemia before a gout diagnosis may play a role.

Women also tend to be diagnosed at an older age at lower levels of elevated uric acid. Although gout management is "suboptimal," and men are more likely to be prescribed urate lowering therapy, this was not enough to account for the difference.

Prolonged exposure to hyperuricemia “may be lengthened further if clinicians are less vigilant for gout in women, potentially delaying diagnosis and increasing crystal and inflammatory burden,” the study authors warn.

Only one quarter of gout patients in primary care are screened for cardiovascular risk factors, they add.

 

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