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TOPLINE:

Patients with gout and hyperuricemia harboring cardiovascular (CV) monosodium urate (MSU) deposits in atherosclerotic plaques are at an increased risk for major adverse cardiovascular events (MACE).

METHODOLOGY:

• Traditional risk factors do not explain the higher risk for CV events in patients with gout and hyperuricemia; therefore, understanding the association between MSU deposits, frequently present in these conditions, and MACE may help identify patients at higher risk.
• This retrospective cohort study included 189 patients (median age, 68 years) for a median follow-up time of 33 months: 131 with gout, 40 with hyperuricemia, and 18 control individuals who underwent dual-energy CT (DECT) of the affected limb and thorax.
• DECT scans and coronary calcium scores were used to identify MSU deposits in CV plaques.

TAKEAWAY:

• Overall, 85 patients (45%) exhibited CV MSU deposits, including 62 patients with gout, 22 with hyperuricemia, and one control individual.
• Patients with CV MSU deposits had significantly higher cardiac disease marker levels, including C-reactive protein levels (median, 17.1 vs 5.6 mg/L; P = .007), uric acid levels (mean, 7.4 vs 6.4 mg/dL; P = .007), and calcium scores (median, 469.5 vs 5.35; P < .001), than those without the deposits.
• MACE occurred in 35 patients and were more frequent in patients with CV MSU deposits (25.9%) than in those without (12.5%; odds ratio, 2.4; P = .018).
• MACE incidence was significantly higher in patients with MSU deposits (31.8 vs 6.7 cases per 1000 patient-years).

IN PRACTICE:

"By demonstrating the increased risk for MACE in patients with CV MSU deposits, our results highlight the urgent need for an improved management in these patients," the authors wrote.

SOURCE:

This study was led by Julia Held, Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria, and published online on April 23, 2024, in Rheumatology.

LIMITATIONS:

The retrospective study design may have led to incomplete documentation of MACE. The small sample size may have exaggerated the effect of CV MSU deposits. Participation of patients with known CV disease could have introduced selection bias. The control group was different from the gout and hyperuricemia groups, making it difficult to directly compare their outcomes.

DISCLOSURES:

The study was not supported by any specific funding. The authors declared no conflicts of interest.