Background/Purpose: Gout is associated with increased CV risk, both dependent on, and independent of traditional CV risk factors.  Recent studies suggest that OA, traditionally considered non-inflammatory, may also carry increased CV risk.  To date, few studies have directly compared the relative CV risk of individual rheumatologic diseases.  We used the VA NY Harbor Health Care System electronic medical record to compare the rates of CV risk factors and prevalence of CV outcomes among patients with gout versus OA, the two most common forms of arthritis in the US. We also determined CV outcome prevalence in patients with both gout and OA concurrently.

Methods: We identified male patients with an active medical record between January 2007 and June 2008 and an ICD-9 code for gout.  We further separated the cohort into gout patients who did (gout+OA), or did not (gout-only) have a concurrent ICD-9 code for OA.  Additionally, we identified patients with diagnostic codes for OA but no gout (OA-only).  For each group we collected demographics, diagnoses of CV risk factors, and diagnoses of CV events.  The primary outcome was a composite index (CV4) consisting of any diagnosis of MI, angina, CABG surgery, and/or CAD. Secondary outcomes included the individual diagnoses within the CV4, as well as CHF and death (all causes). One-way ANOVA with Tukey post-hoc comparisons were used to test for differences between groups.

Results: 1280 subjects had an ICD-9 diagnosis of gout.  Of these, 297 had gout+OA, and 983 had gout-only.  We further identified 1231 OA-only subjects. Gout+OA, gout-only, and OA-only subjects were similar in age and ethnicity.  Gout subjects, with or without OA, had higher baseline rates of CV risk factors including HTN, HLD, and chronic kidney disease (p<0.0001 for each comparison) than OA-only subjects.  Gout-only subjects had higher rates of DM vs OA-only subjects (p=0.011).  Gout subjects, with or without OA, had higher prevalence rates of CV4 events versus OA-only subjects; individual component outcomes were also more prevalent among the gout subjects with or without OA (Table 1).  Gout subjects, with or without OA, had higher rates of CHF and death compared with OA-only patients.  Gout+OA subjects demonstrated non-significant trends towards increased CV4, CAD, CHF and death vs. gout-only subjects. Patients with gout+OA, but not gout-only, had increased rates of death compared to OA alone.

Conclusion: Adverse CV outcomes occur more commonly among gout patients compared with patients with OA only, at least partly due to greater prevalence of traditional risk factors. We also observed non-significant trends towards increased risk of some CV outcomes (CV4, CAD, CHF, death) in patients with both gout+OA compared to patients with gout-only, and only gout+OA patients had increased mortality compared to OA alone. Larger sample sizes may clarify whether there is an additive effect of gout and OA on CV outcomes.