ASYMPTOMATIC HYPERURICEMIA (AH) CONVEYS AN INDEPENDENT FROM GOUT INCREASE IN RISK FOR CORONARY ARTERY DISEASE (CAD)

Background: Epidemiologic studies suggest that high serum uric acid (UA) levels increase the risk for cardiovascular (CV) disease, but it is unknown whether gout per se conveys CV risk beyond that of asymptomatic hyperuricemia (AH). Objectives: To assess whether AH and/or gout are associated with increased rates of coronary artery disease (CAD). Methods: We conducted a prospectively-enrolled, cross-sectional pilot study. Male patients ages 55-85 were recruited during routine visits to the primary care clinic of the Veteran Affairs Healthcare System. All patients underwent serum UA determination and an interview including gout screen and CAD self-assessment. Enrollees were then divided into 3 cohorts: controls (no gout, UA≤6.8 mg/dl), AH (no gout; UA>6.8mg/dl), and gout. Chart review was performed (ICD-9 code identification plus review of the primary care and/or cardiology note) to confirm gout, CAD and background comorbidities. For sub-analysis, patients with AH and gout were each further subdivided into equal cohorts with the lowest and highest UA levels. Results: 91 patients have been enrolled to date: 48 controls, 24 AH and 19 gout patients. Mean serum UA for AH and gout were similar (7.9±1 and 8.27±2.6 mg/dl, respectively), but both were significantly higher than controls (5.6±0.77 mg/dl). Mean age (controls, 68.5±8.2; AH, 67.5±9; gout, 71.8±8.36 years), BMI (29.1±11.9; 30.2±6.8; 30.8±3.4, respectively); prevalence of diabetes mellitus (41.7%; 41.7%; 42.1%, respectively) and dyslipidemia (66.7%; 75%; 66.7%, respectively) were similar in all cohorts. Patients with gout had lower smoking rates (controls, 25%; AH, 16.7%; gout, 10.5%), but somewhat more hypertension (77.1%; 83.5%; 89.5%, respectively) than the other cohorts. Self-reported CAD rates were 20.8% (controls), 29.2% (AH) and 36.8% (gout). Compared to controls (25%), chart-confirmed CAD rates were increased for gout (36.8%), and intermediate for AH (29.2%). When AH patients were separated into lower (UA=6.9-7.5 mg/dl) and higher (UA=7.6-10.5 mg/dl) UA ranges (n=12 each), the higher range group had more CAD (25% versus 33.3% respectively). Gout patients with high serum UA also had a higher prevalence of CAD, though our data do not permit us to determine whether this represents an effect of hyperuricemia, or a marker for gout severity. Conclusions: The results of this well-controlled, ongoing, prospectively-enrolled pilot study suggest that AH is an independent risk factor for CAD, and that the presence of gout conveys an additional level of independent CAD risk beyond that of AH. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 438Session: Epidemiology, health services and outcome research (Poster Presentations )