O31. Gout and Risk of Subsequent Vascular Event: A Discrete-Time Event History Analysis in the Clinical Practice Research Datalink

Clarson, Lorna E.; Hider, Samantha L.; Belcher, John; Roddy, Edward; Heneghan, Carl; Mallen, Christian D.

Abstract

Background: Current evidence suggests that gout is an independent risk factor for excess cardiovascular morbidity and mortality; yet, suboptimal care for patients with gout in primary care persists. We aimed to identify risk factors specific to these gout patients which may contribute to their increased risk of vascular disease.

Methods: Discrete-time event history analysis was used to estimate the contemporaneous effect of changing vascular risk factors on the risk of an incident vascular event (cardiovascular, cerebrovascular or peripheral vascular) in each year following diagnosis of gout for 8386 primary care gout patients over the age of 50 with no prior history of vascular disease, using records from the Clinical Practice Research Datalink.

Results: Older age, higher Charlson co-morbidity score, incident prescription of anti-platelet or lipid-lowering medications, measurement of blood pressure or body mass index (whether normal or high) and a mean daily dose of 300 mg of allopurinol or less were associated with an increased risk of a vascular event. Female gender, incident diagnosis of hyperlipidaemia or chronic kidney disease and increasing persistence with allopurinol (measured using the medication persistence ratio) all reduced the risk of a vascular event.

Conclusion: The effect of some risk factors differed from those previously reported using continuous survival analysis, with increased risk of vascular event associated with measuring blood pressure and body mass index even when recorded as normal, and hyperlipidaemia and chronic kidney disease appearing protective, perhaps demonstrating that those most at risk are those not under surveillance for alternative reasons. This would support the introduction of a routine vascular surveillance from diagnosis of gout.

Citation

Clarson, L. E., Hider, S. L., Belcher, J., Roddy, E., Heneghan, C., & Mallen, C. D. (2015). O31. Gout and Risk of Subsequent Vascular Event: A Discrete-Time Event History Analysis in the Clinical Practice Research Datalink. Rheumatology, 54(S1), https://doi.org/10.1093/rheumatology/kev084.001

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 20, 2015
• Publication Date: 2015-04
• Deposit Date: Aug 25, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 54
• Issue: S1
• DOI: https://doi.org/10.1093/rheumatology/kev084.001