Abstract
BackgroundGout is associated with higher cardiovascular risk that increases with disease severity. The objective of this study was to explore the relationship between the extent of monosodium urate (MSU) crystal deposition, assessed with ultrasonography (US) and dual-energy computed tomography (DECT), and cardiovascular risk.MethodsGout patients were included in this cross-sectional study to undergo DECT scans for the assessment of total MSU volume deposition in the knees and feet, and US to evaluate the number of joints with the double contour (DC) sign. Participants were screened for traditional cardiovascular risk factors, and levels of the American College of Cardiology (ACC)/American Heart Association (AHA) 10-year risk for heart disease or stroke were calculated. The primary endpoint was the Spearman correlation coefficient ρ between DECT MSU volume and cardiovascular risk.ResultsA total of 42 patients were included; they were predominantly male (40/42) and aged 63.0 ± 13.2 years. Overall, 28/42 patients presented with the metabolic syndrome and the average 10-year coronary event or stroke risk according to the ACC/AHA (n = 33) was 21 ± 15%. Correlations between DECT volumes of MSU deposits in the knees, feet, and knees + feet and cardiovascular risk according to the ACC/AHA were very poor, with ρ = 0.18, −0.01, and 0.13, respectively. The was no correlation between the number of joints with the DC sign and cardiovascular risk (ρ = −0.07). DECT MSU deposit volume was similar in patients with and without metabolic syndrome (p = 0.29).ConclusionsThe extent of MSU burden does not increase the estimated risk of cardiovascular events in gout patients.
Highlights
Gout is associated with higher cardiovascular risk that increases with disease severity
Patients Consecutive patients with a diagnosis of gout according to the American College of Rheumatology (ACR)/ European League Against Rheumatism (EULAR) 2015 criteria [12] were prospectively recruited to undergo a quantification of urate deposition in the knees and feet using US and dual-energy computed tomography (DECT) [8], and an assessment of their cardiovascular risk
Correlations between DECT volumes of monosodium urate (MSU) deposits in the knees, feet, and knees + feet and cardiovascular risk according to the American College of Cardiology (ACC)/American Heart Association (AHA) were very poor, with ρ = 0.18, −0.01, and 0.13, respectively (Fig. 2), and did not differ significantly from zero (p > 0.05)
Summary
Gout is associated with higher cardiovascular risk that increases with disease severity. Cardiovascular risk in gout seems to increase with disease severity, the presence of clinical tophi, and serum urate (SU) levels [5]. In non-gout patients, SU levels may be associated with higher cardiovascular risk scores but causality of hyperuricemia on cardiovascular comorbidities and events, and the metabolic syndrome, remains uncertain [3, 7]. The association between MSU crystal burden and traditional cardiovascular risk factors needs to be studied. Were they to be correlated, quantifying MSU deposition could help identify gout patients at high cardiovascular risk
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