Major cardiovascular events in patients with cardiovascular monosodium urate deposits in atherosclerotic plaques

Julia Held; Christoph Schwabl; David Haschka; Sarah Maier; Gudrun Feuchtner; Gerlig Widmann; Christina Duftner; Günter Weiss; Andrea Klauser

doi:10.1093/rheumatology/keae240

Major cardiovascular events in patients with cardiovascular monosodium urate deposits in atherosclerotic plaques

Rheumatology (Oxford). 2024 Apr 23:keae240. doi: 10.1093/rheumatology/keae240. Online ahead of print.

Authors

Julia Held¹, Christoph Schwabl², David Haschka¹, Sarah Maier², Gudrun Feuchtner³, Gerlig Widmann³, Christina Duftner¹, Günter Weiss¹, Andrea Klauser³

Affiliations

¹ Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria.
² Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
³ Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.

PMID: 38652590
DOI: 10.1093/rheumatology/keae240

Abstract

Objective: To determine the association of cardiovascular atherosclerotic plaque monosodium urate deposits with the occurrence of major cardiovascular events in gout and hyperuricemia patients.

Methods: This retrospective cohort study included patients with clinically suspicion of gout, who performed a dual energy computed tomography of the affected limb and thorax between June 1st, 2012 and December 5th, 2019. Clinical and laboratory parameters were retrieved from patientś charts. Established cardiovascular risk factors were evaluated. Medical history review identified the presence of major adverse cardiac events with a median follow up time of 33 months (range 0-108 months) after the performed computed tomography scan.

Results: Full data sets were available for 189 patients: 131 (69.3%) gout patients, 40 (21.2%) hyperuricemia patients, and 18 (9.5%) controls. Patients with cardiovascular monosodium urate deposits (n = 85/189, 45%) revealed increased serum acute phase reactants, uric acid levels and calcium scores in computed tomography compared with patients without cardiovascular monosodium urate deposits. Major adverse cardiac events were observed in 35 patients (18.5%) with a higher prevalence in those patients revealing cardiovascular monosodium urate deposits (n = 22/85, 25.9%) compared with those without cardiovascular monosodium urate deposits (n = 13/104, 12.5%, OR 2.4, p= 0.018).

Conclusion: This is the first study demonstrating the higher hazard of major adverse cardiac events in patients with dual energy computed tomography-verified cardiovascular monosodium urate deposits. The higher prevalence of cardiac events in patients with cardiovascular monosodium urate deposits may facilitate risk stratification of gout patients, as classical cardiovascular risk scores or laboratory markers fail in their proper identification.

Keywords: DECT; Gout; Hyperuricemia; MACE; Monosodium urate; calcium score; cardiovascular risk.