Risk of incident vascular disease in patients with gout: an observational study in the Clinical Practice Research Datalink

Clarson, Lorna Elise

Abstract

Gout is the most prevalent inflammatory arthritis, predominantly managed in primary care. Both hyperuricaemia (the biochemical precursor to gout) and other inflammatory arthritides, e.g. rheumatoid arthritis, have been shown to increase risk of vascular disease. This thesis aims to investigate the risk of incident cardiovascular, cerebrovascular and peripheral vascular disease in primary care gout patients.

A systematic review identified 17 studies investigating gout and vascular diseases. Meta-analysis showed increased mortality from all cardiovascular and coronary heart disease. Increased incidence of, but not mortality from myocardial infarction was found. Few studies investigated the association between gout and cerebrovascular or peripheral vascular disease.

A retrospective cohort study used data from the Clinical Practice Research Datalink to examine the risk of incident cardiovascular, cerebrovascular and peripheral vascular disease in 8386 gout patients and 39766 age-, gender- and practice-matched controls, in the ten years following diagnosis of gout (or matched date) using Cox proportional hazards and multilevel discrete-time event history analysis. Risk was also investigated by gender and with follow-up limited to one, two and five years. The effect of exposure to drugs used to treat both gout and vascular risk factors on the magnitude of risk was examined using a cohort and nested case-control study design.

The strongest association identified was between gout and peripheral vascular disease. Women with gout had the greatest excess vascular risk and experienced a wider range of vascular events. Exposure to drugs used to manage vascular risk factors was associated with increased likelihood of a vascular event, but use of gout treatments such as allopurinol did not influence incident vascular risk.

This suggests that gout patients, particularly women, should have screening for and aggressive management of vascular risk factors, although as conventional approaches may be insufficient, further research is required to establish the optimum risk reduction strategy.

Citation

Clarson, L. E. (2015). Risk of incident vascular disease in patients with gout: an observational study in the Clinical Practice Research Datalink