Background/Purpose: We have not found a study determining cardiovascular (CV) risk in the different stages of gout. This led us to use a complex multimodal ultrasonography in order to assess the independent influence of the different stages of gout on parameters associated with CV risk: renal resistive index (RRI), left ventricular mass index (LVMI), Em – reflecting diastolic function of the heart, intima-media thickness (IMT) and common carotid artery resistive index (CCARI).

Methods: A total of 170 patients (pts) were examined cross-sectionally, divided into four groups. Control group – pts with osteoarthritis who were with conventional CV risk factors (arterial hypertension, diabetes mellitus, obesity, dyslipidemia, reduced eGFR, smokers), normal level of serum uric acid and no history of gouty crisis (n=35), 15 males and 20 females aged 61±9.7 years. The other three groups of pts were asymptomatic hyperuricemia (n=41), 23 males and 18 females aged 54.6±15.6 years, gout pts without tophi (n=52), 45 males and 7 females aged 55.9±11.6 years and gouty tophi pts (n=42), 41 males and 1 female aged 58.8±11.4 years. All pts underwent a complex multimodal ultrasonography done by one researcher unaware with clinical and laboratory data. RRI was measured in both kidneys with 3.5 MHz transducer. Echocardiography was done by 2.5 MHz transducer. Carotid arteries were examined with 10 MHz linear transducer. Statistical analyses were performed by ANOVA, Kruskal-Wallis, chi-square tests. We conducted a multiple logistic regression to pts with osteoarthritis. In this way we assessed the independent influence of the three stages of gout and CV risk factors on measured parameters. The cutoff for RRI was >0.70; for LVMI>125 g/m² in males and >110 g/m² in females; for Em<0.08 m/s; for IMT>0.90 mm; for CCARI>0.70.

Results: Of conventional CV risk factors we revealed 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. We established 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), 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 increased 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 different stages of gout had no independent impact on LVMI, Em and RRI.

Conclusion: Tophi raised the likelihood of having abnormal CCARI three times more than arterial hypertension. CCARI is a well known independent predictor of higher CV risk. We suggest that tophi in gout are independent, commensurable and even stronger risk factor than arterial hypertension.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-strong-cardiovascular-risk-factor-are-gouty-tophi/