Plasma lipoproteins, glucose tolerance and insulin response in primary gout

Abstract

In the gouty population there is a high incidence of coronary disease risk factors, including, besides hyperuricemia, those of hypertension, hypertriglyceridemia and diminished glucose tolerance. All these abnormalities are also very common in obesity. To test the existence of a possible association between gout per se and abnormalities of lipid or carbohydrate metabolism lipoprotein phenotypes, glucose tolerance and immunoreactive insulin responses were studied in fourteen patients with primary gout and in fourteen age- and weight-matched control patients without gout. All subjects were male without clinical diabetes mellitus, hypertension or overt atherosclerotic disease, and weighed less than 125 per cent of ideal weight. The only abnormal lipoprotein phenotype observed was type IV hyperlipoproteinemia (hyperprebetalipoproteinemia), which was present in six gouty subjects but in only one control subject. Neither oral nor intravenous glucose tolerance, nor the corresponding absolute insulin responses differed significantly between the gouty and nongouty control group, nor between the gouty subjects with and without hyperlipoproteinemia. However, in relation to the glycemic stimulus the gouty subjects with type IV hyperlipoproteinemia secreted significantly more insulin after oral, but not after intravenous, glucose administration than either the gouty subjects without hyperlipoproteinemia or the nongouty control subjects. These results indicate a direct relationship between primary gout and primary type IV hyperlipoproteinemia, independent of obesity and of carbohydrate intolerance.