Uric Acid Level Is Not An Independent Predictor Of Cardiovascular Diseases In Gout Patients With Treatment; Long-Term Follow-Up Data In Single Tertiary Center In South Korea

Seulkee Lee¹, Eun-Jung Park², Jinseok Kim³, Chan Hong Jeon⁴, Hyungjin Kim⁵, Jaejoon Lee¹, Eun-Mi Koh¹ and Hoon-Suk Cha¹, ¹Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, ²Internal Medicine, Department of Medicine, Jeju National University Hospital, Jeju University School of Medicine, Republic of Korea, Jeju, South Korea, ³Internal Medicine, Jeju National University Hospital, Jeju, South Korea, ⁴Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea, ⁵Department of medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, Gout and uric acid

Session Information

Title: Metabolic and Crystal Arthropathies II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Hyperuricemia and gout are closely related conditions that are prevalent worldwide. A possible link between hyperuricemia and cardiovascular diseases (CVD) has been a debated clinical topic for many decades. In particular, no study showed long-term cumulative effect of serum uric acid on CVD in gout patients with treatment.

The aim of this study is to evaluate the cardiovascular outcomes and determined cumulative impact of long-term uric acid level on CVD in gout patients with uric acid lowering treatment.

Methods: All patients who had first visit for gout at Samsung Medical Center between 1995 and 2002 and follow-up until December 2012 or expired during follow-up period were included and retrospective analyzed. Demographics, laboratory data and cardiovascular outcomes were evaluated. Mixed effect model and multi-variable analysis were used to determine the cumulative effect of long-term, repeated uric acid level on CVD.

Results: Two-hundred seventy-three patients with gout were observed. Of these, 49 (17.9 %) patients developed at least one of the CVD during follow-up period. Seven of the 49 patients showed two different kinds of CVD. Twenty-nine cases of coronary heart disease (CHD) or congestive heart failure (CHF), 24 cases of cerebral infarction or transient ischemic attack (TIA) and 4 cases of peripheral arterial occlusive diseases (PAOD). Mean age of diagnosis of gout was 45.4 and mean follow-up duration was 11.5 years. Baseline characteristics between patients with or without CVD showed no significant difference except incidence of hypertension. The cumulative effect of long-term uric acid level on CVD did not showed statistical significance according to mixed effect model (P = 0.13) and also multi-variable analysis after adjusting confounding factors (P = 0.07). Chronic kidney disease (CKD), duration of gout and hypertension were risk factors for CVD in gout patient with uric acid lowering treatment by multi-variable analysis (P = 0.01, P = 0.01 and P= 0.01, respectively)

Conclusion: Our data demonstrated a long-term cumulative effect of uric acid may a cause for factors that are in the causal pathway for CVD rather than an independent predictor for CVD in gout patients with uric acid lowering treatment. CKD, duration of gout and hypertension were found to be the sole predictors for CVD in gout patients with treatment.

Disclosure:

S. Lee,
None;

E. J. Park,
None;

J. Kim,
None;

C. H. Jeon,
None;

H. Kim,
None;

J. Lee,
None;

E. M. Koh,
None;

H. S. Cha,
None.

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