Background/Purpose:  Studies on gout and its stages as a cardiovascular (CV) risk factor are few and with contradictory results. We compared echocardiographic parameters, known as independently associated with CV risk, and the scores obtained by using the Framingham Risk Score (FRS) in order to establish the differences in CV risk between obese and non-obese patients (pts) in the individual stages of gout.

Methods:  A total of 201 pts were examined cross-sectionally, divided into three groups: asymptomatic hyperuricemia (n=52), 29 males and 23 females aged 55.23±15.94 years; gouty arthritis without tophi (n=86), 71 males and 15 females aged 56.36±12.29 years and gouty tophi (n=63), 60 males and 3 females aged 58.89±11.03 years. Obesity was defined as body mass index (BMI)>30 kg/m². FRS was calculated. Pts underwent echocardiography performed by one investigator, unaware of the cases clinical data, with 2.5MHz transducer. The following parameters were measured: left atrium (LA) size, thickness of the interventricular septum (IVS) and of posterior wall (PW) of the left ventricle in end-diastolic phase, fractional shortening (FS), Sm – reflecting systolic function of the left ventricle, Em – a sensitive indicator of diastolic dysfunction and E/Em ratio – an indicator of left ventricular filling pressure. Data were analyzed by Kolmogorov-Smirnov, t-test, Mann-Whitney, ANOVA test and multiple linear regression.

Results:  In asymptomatic hyperuricemia 22 (42.3%) of the pts were obese. In this group no difference was estimated in FRS (p=0.187), FS (p=0.885), Sm (p=0.400), Em (p=0.459) and E/Em (p=0.422) between obese and non-obese pts. However, obese pts had larger LA (mean±SD; 40.68±5.22 vs 36.50±5.37 mm, p=0.007), thicker IVS (mean±SD; 12.71±1.46 vs 11.18±2.18 mm, p=0.006) and thicker PW (mean±SD; 12.41±1.66 vs 10.48±2.03 mm, p=0.002). In gouty arthritis without tophi 41 (47.7%) of the pts had obesity. FRS (p=0.238), FS (p=0.110), Sm (p=0.341), Em (p=0.430) and E/Em (p=0.887) were equal between obese and non-obese pts, but obese pts had larger LA (mean±SD; 39.66±4.36 vs 36.60±5.12 mm, p=0.004), thicker PW (mean±SD; 12.71±1.67 vs 12.05±1.89 mm, p=0.037) and tended to have thicker IVS (mean±SD; 12.74±1.50 vs 12.02±1.87 mm, p=0.054). Twenty six (41.3%) of gouty tophi were obese. Comparison between obese and non-obese gouty tophi pts showed no difference in FRS (p=0.990), FS (p=0.157), Sm (p=0.830), Em (p=0.059) and E/Em (p=0.138). Likewise, pts with obesity had larger LA (mean±SD; 42.45±5.96 vs 39.25±5.84 mm, p=0.039), thicker PW (mean±SD; 13.50±2.46 vs 12.13±1.77 mm, p=0.007) and a tendency of thicker IVS (mean±SD; 13.17±1.42 vs 12.26±2.05 mm, p=0.056). Multiple linear regression, adjusted for age, revealed that the increase of BMI was a factor for thickening of the PW in asymptomatic hyperuricemia (r²=0.565), gouty arthritis without tophi (r²=0.305) and gouty tophi (r²=0.261).

Conclusion:  In the three stages of gout obese subjects had more pronounced alterations in the heart morphology, although the lack of differences in the left ventricular function and in the FRS. The simultaneous use of FRS and echocardiography contribute for a more complete assessment of CV risk in gout.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/obesity-and-echocardiographic-changes-in-the-different-stages-of-gout/