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Summary
How strong is the link between gout and coronary artery disease? In this educational activity, Dr. Krishnan discusses the Multiple Risk Factor Intervention Trial (MRFIT), which was designed to isolate gout as a risk factor in order to study this relationship.
The MRFIT trial was of 6 years duration, with 17 years of follow-up. Over 13,000 men aged 35 to 57 years, considered to be at high cardiovascular risk, were randomized to usual care versus stepped up care (diuretic based blood pressure control, diet and exercise). Some participants developed gout during the study whereas others had it from baseline. Dr. Krishnan shows the multivariable logistic regression analysis of the initial randomization study, which found that gout is associated with an excess risk of acute MI that is not explained by renal function, metabolic syndrome, diuretic use, or traditional cardiovascular risk factors.
The 17-year follow-up study was designed to look at the association between gout and cardiovascular risk in 9,105 participants aged 41 to 63 at baseline who were at above-average risk for coronary heart disease. This longer-term study showed a significant relationship between the presence of gout plus elevated uric acid levels and risk of CVD mortality.
Based on the available literature, Dr. Krishnan presents a model of the putative pathophysiological links between gout and cardiovascular disease, which may explain the relationship observed in epidemiological studies. Whether this risk can be mitigated by medications or other interventions remains to be seen in future studies.
Copyright ©2009 American Academy of CME and E-MedHosting.com Inc.
Learning objectives
After viewing this presentation the participant will be able to:
-Screen patients with hyperuricemia and gout in your practice for associated cardiovascular risk factors
- Evaluate the increased risk of acute myocardial infarction due to gout in your middle-aged male patients
Bibliographic references
Krishnan E. Gout and coronary artery disease: epidemiologic clues. Curr Rheumatol Rep. 2008 Jul;10(3):249-55.
Krishnan E, Baker JF, Furst DE, Schumacher HR. Gout and the risk of acute myocardial infarction Arthritis Rheum. 2006 Aug;54(8):2688-96.
Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH; MRFIT Research Group. Long-term Cardiovascular Mortality Among Middle-aged Men With Gout Arch Intern Med. 2008;168(10):1104-1110.
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