Cardiovascular disease and gout: Real-world experience evaluating patient characteristics, treatment patterns, and health care utilization

Abstract

BACKGROUND: Gout, hyperuricemia, and cardiovascular disease (CVD) are prevalent conditions in the United States, and while they share common risk factors such as obesity, hypertension, hypercholesterolemia, and type 2 diabetes mellitus, relatively little is known about what patient and disease characteristics may link CVD with hyperuricemia and gout and how the presence of both diseases affects management decisions differently than for patients with gout alone. OBJECTIVE: To identify differences in patient characteristics, patterns of urate-lowering therapy (ULT) use, and gout control in gout patients with and without cardiovascular comorbidity. METHODS: Data were assessed from a survey of U.S. physicians who performed in-depth patient chart audits of their last 5 consecutive adult patients with confirmed gout as determined by the medical record and clinical notes. Comorbidities, gout symptoms, length of current treatment, sociodemographic factors, and physician type were identified from the chart review. Descriptive statistics and logistic regression described differences among patients with and without comorbid CVD and assessed ULT use and gout control. RESULTS: Of the 1,159 patient charts that were reviewed, 738 patients had CVD and gout, and 421 had gout alone. Patients with CVD had longer duration of gout (mean [[]SD] = 52 [[]68.2] vs. 34 [[]47.2] months; P < 0.001) and were more likely to have clinician-reported tophi (28[%] vs. 15[%]; P< 0.001), organ/joint damage (19[%] vs. 9[%]; P< 0.001), and more flares (2.1[%] vs. 1.8[%]; P = 0.017) in the previous 12 months. Time from gout diagnosis to start of ULT was delayed for those with CVD (mean [[]SD] = 24.3 [[]56.6] vs. 15.5 [[]33.2] months; P = 0.023), but these patients were more likely to be receiving ULT (83[%] vs. 59[%]; P< 0.001). Gout patients with CVD were more likely to have a variety of additional comorbidities than those without CVD, such as obesity (28[%] vs. 18[%]; P < 0.001), diabetes (26[%] vs. 12[%]; P < 0.001), osteoarthritis (25[%] vs. 11[%]; P< 0.001), chronic kidney disease (17[%] vs. 5[%]; P< 0.001), and prostate disease (males, n = 933; 10[%] vs. 2[%]; P< 0.001). Gout patients with CVD were more likely to have an emergency department visit (12[%] vs. 7[%]; P = 0.003) for gout in the previous 12 months. In patients with CVD, ULT use was associated with better gout control. CONCLUSIONS: Gout patients with CVD were more likely to have additional comorbidities, more gout-related symptoms, and a delay in initiating treatment, which may be associated with the greater severity of disease in these patients. These data suggest that gout patients with CVD may constitute a less healthy group in need of earlier, more aggressive therapy.