THU0411 STRUCTURED CARDIOVASCULAR ASSESSMENT INCLUDING CAROTID ULTRASOUND IN GOUT: ANALYSIS OF SUBSEQUENT EVENTS IN THE FOLLOW UP
Authors: M. Monzó, N. Quilis Marti, L. Ranieri, A. San-Martín, M. Andrés
Journal: Annals of the Rheumatic Diseases (2020)

Background: Gout is an independent cardiovascular (CV) risk factor. This excess of morbidity and mortality requires optimal management, especially in high-risk individuals. So, the inclusion of subclinical atherosclerosis screening by carotid ultrasound in the initial evaluation may help to accurately stratify the CV risk. However, longitudinal outcomes using this technique are not available in gout. Objectives: To analyze the new CV events occurred in patients with gout after structured CV assessment incorporating carotid ultrasound. Methods: Retrospective analysis of an inception cohort of new patients with crystal-proven gout. At baseline, a structured CV assessment was performed considering age, gender, traditional risk factors, CV and renal disease, laboratory data, SCORE and Framingham risk tools and carotid ultrasound; according to 2013 ESC guidelines, CV risk was stratified as low, moderate, high or very high. The cohort includes 356 patients, mean aged 64 years (SD 14.0) mostly males (86.0%), 21.8% with tophaceous gout and mean serum urate at diagnosis of 8.2mg/dL (SD 1.8). The CV risk stratification was: low in 20 (5.6%), moderate in 47 (13.2%), high in 34 (9.6%), and very high risk in 242 (68.0%). Major CV events (coronary disease (CD), heart failure (HF), stroke, peripheral artery disease (PAD) and CV death) were recorded during the follow-up by electronic case reports review. A binary composite endpoint of “new major CV event” was used. The incidence after inclusion in the cohort was estimated. To evaluate potential baseline predictors (clinical and gout-related) of CV events, a Cox regression model was built. Results: Mean follow-up in the cohort was 41.5 months (SD 16.8). Forty new major CV events have been identified (incidence 3.25%/patient-year), distributed as follows: HF 1.46 (n=18), CV death 0.65 (n=8), CD 0.49 (n=6), stroke 0.33 (n=4), and PAD 0.33%/patient-year (n=4). Per risk stratification, the incidence of a new event was 0.16%/patient-year in the high-risk group and 3.01%/patient-year in the very high-risk, while no events occurred in low and moderate groups. The table shows the univariate and multivariate analysis of baseline variables. An independent association and a trend towards significance were noted for age and to be classified at a very high CV risk at baseline, respectively. Univariate regression Multivariate regression HR (95%CI) P HR (95%CI) P Age 1.07 (1.04-1.11) &lt;0.001 1.04 (1.00-1.08) 0.031 Female gender 3.27 (1.68-6.33) &lt;0.001 1.24 (0.55-2.81) 0.605 Body mass index 1.00 (0.94-1.06) 0.863 - - Glomerular filtration rate 0.98 (0.97-0.99) &lt;0.001 1.00 (0.99-1.01) 0.766 Very high CV risk at baseline 9.54 (2.30-39.64) 0.002 4.11 (0.89-19.02) 0.070 Serum urate at diagnosis 1.19 (1.00-1.42) 0.052 1.12 (0.94-1.33) 0.227 ULT at diagnosis 0.81 (0.29-2.27) 0.688 - - Tophi 1.33 (0.66-2.66) 0.422 - - Years since first flare 1.00 (0.97-1.03) 0.772 - - Number of flares suffered 0.99 (0.97-1.00) 0.255 - - Number of involved joints 1.00 (0.89-1.12) 0.976 - - Joint pattern at presentation -Monoarticular 1.00(ref) - 1.00(ref) - -Oligoarticular 1.86 (0.91-3.80) 0.089 1.35 (0.65-2.82) 0.421 -Polyarticular 2.75 (1.05-7.22) 0.039 1.34 (0.48-3.76) 0.579 HR: Hazard ratio; 95%CI: 95% confidence interval. Conclusion: First longitudinal study assessing the use of subclinical atherosclerosis screening as part of CV risk assessment in new patients with gout. Those classified at the very high-risk group presented the majority of events, being HF the most frequent. Age, and likely to be classified as very high risk, independently predicted a new CV event during follow-up, data that may be of interest in terms of management of the patient with gout at the time of diagnosis. Disclosure of Interests: : Mar Monzó: None declared, Neus Quilis Marti: None declared, Laura Ranieri: None declared, Alejandro San-Martín: None declared, Mariano Andrés Grant/research support from: Grünenthal, Consultant of: Grünenthal, Menarini, Speakers bureau: Grünenthal, Horizon