Cardiovascular Risk in Type 2 Diabetic Patients With Asymptomatic Hyperuricemia and Gout

Open access

Abstract

Aim: To study the differences in cardiovascular risk between type 2 diabetic and non-diabetic patients with asymptomatic hyperuricemia and gout using the Framingham Risk Score (FRS) and complex multimodal ultrasonography.

Patients and methods: A total of 201 patients participated, divided into two groups: 1/ patients with asymptomatic hyperuricemia (n = 52), and 2/ patients with gout (n = 149). FRS was determined as well as ultrasound parameters, independent predictors of cardiovascular risk: left atrial size (LA), intima-media thickness (IMT) and common carotid artery resistive index (CCARI).

Results: The patients in the two groups were age-matched and conventional cardiovascular risk factors were equally distributed. In the asymptomatic hyperuricemia group, 12 patients (23.1%) had diabetes. In this group, there was no difference in FRS between diabetic and non-diabetic individuals. However, diabetic patients had larger LA, thicker intima-media and higher CCARI. In the gout group 18 subjects (12%) had diabetes, but the FRS, LA, IMT and CCARI values were similar among diabetic and non-diabetic patients. Furthermore, when gout subjects were subdivided according to the presence of tophi, we found that the subgroup having gouty tophi and diabetes had larger LA (p = 0.014) compared to those with gouty tophi without diabetes.

Conclusion: In diabetic patients with asymptomatic hyperuricemia and gouty tophi, a more complex approach for estimation of cardiovascular risk is needed. Our work suggests that diabetes and tophi might potentiate their action on the cardiovascular system.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Kim SY Guevara JP Kim KM et al. Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum. 2009; 61:885-892.

  • 2. Zhu Y Pandya BJ Choi HK. Comorbidities of gout and hyper-uricemia in the US general population: NHANES 2007-2008. Am J Med. 2012; 125(7):679-687.

  • 3. Lai HM Chen CJ Su BY et al. Gout and type 2 diabetes have a mutual inter-dependent effect on genetic risk factors and higher incidences. Rheumatology 2012; 51(4):715-20.

  • 4. Carnethon MR Fortmann SP Palaniappan L et al. Risk factors for progression to incident hyperinsulinemia: the Atherosclerosis Risk in Communities Study 1987-1998. Am J Epidemiol 2003; 158(11):1058-67.

  • 5. Boyle JA McKiddie M Buchanan KD et al. Diabetes mellitus and gout. Blood sugar and plasma insulin responses to oral glucose in normal weight overweight and gouty patients. 1969; Annals of the Rheumatic Diseases; 28(4):374-8.

  • 6. Niskanen L Laaksonen DE Lindstrom J et al. Serum uric acid as a harbinger of metabolic outcome in subjects with impaired glucose tolerance: the Finnish Diabetes Prevention Study. Diabetes Care; 29(3):709-11.

  • 7. Choi HK De Vera MA Krishnan E. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile. Rheumatology 2008; 47(10):1567-10.

  • 8. Kim SC Solomon DH. Risk of incident atrial fibrillation in gout: a cohort study. Ann Rheum Dis. 2016; 75(8):1473-8.

  • 9. Rho YH Lu N Peloquin CE et al. Independent impact of gout on the risk of diabetes mellitus among women and men: a population-based BMI-matched cohort study. Ann Rheum Dis. 2016; 75(1):91-5.

  • 10. Pan A Teng GG Yuan JM Koh WP. Bidirectional Association between Diabetes and Gout: the Singapore Chinese Health Study. Scientific reports. 2016 May 10;6:25766. PubMed PMID: 27161168. Pubmed Central PMCID: 4861921.

  • 11. Lanaspa MA Sanchez-Lozada LG Choi YJ et al. Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: potential role in fructose-dependent and -independent fatty liver. J Biol Chem. 2012;287(48):40732-44.

  • 12. Pontremoli R The role of urate-lowering treatment on cardiovascular and renal disease: evidence from CARES FAST ALL-HEART and FEATHER studies Current Medical Research and Opinion 201733:sup3 27-32.

  • 13. Kizer JR Bella JN Palmieri V et al. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: The Strong Heart Study (SHS). Am Heart J. 2006; 151(2):412-418.

  • 14. Staub D Meyerhans A Bundi B et al. Prediction of cardiovascular morbidity and mortality: comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke 2006; 37:800-805.

  • 15. Wallace SL Robinson H Masi AT et al. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977 20(3):895-900.

  • 16. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-97.

  • 17. Grundy SM Cleeman JI Bairey Merz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13;110(2):227-39.

  • 18. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation classification and stratification. Am J Kidney Dis 2002; 39:S1-S266.

  • 19. Heine GH Gerhart MK Ulrich C et al. Renal Doppler resistance indices are associated with systemic atherosclerosis in kidney transplant recipients. Kidney Int 2005; 68:878-885.

  • 20. Lang RM Beirig M Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group developed in conjunction with the European Association of Echocardiography a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18:1440-1463.

  • 21. Dalbeth N Pool B Gamble GD et al. Cellular characterization of the gouty tophus: a quantitative analysis. Arthritis Rheum 2010 62(5):1549-1556.

  • 22. Jørgensen PT Jensen MT Mogelvang R et al. Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics. Diabetes & Vascular Disease Research 2016 13(5) 321-330.

  • 23. Negishi K. Echocardiographic feature of diabetic cardiomyopathy: where are we now? Cardiovasc Diagn Ther 2018;8(1):47-56.

  • 24. Lin JC Lin CL Chen MC et al. Gout not hyperuricemia alone impairs left ventricular diastolic function. Arthritis Res Ther. 2015; 17: 323.

  • 25. Kiechl S Willeit J. The natural course of atherosclerosis. Part 1: incidence and progression. Arterioscler Thromb Vasc Biol. 1999;19(6):1484-1490.

  • 26. Zhang L Yin JK Duan YY et al. Evaluation of carotid artery elasticity changes in patients with type 2 diabetes. Cardiovasc Diabetol. 2014; 13: 39.

  • 27. Cippoli JA Ferreira-Sae MC Martins RP et al. Relationship between serum uric acid and internal carotid resistive index in hypertensive women: a cross-sectional study. BMC Cardiovascular Disorders. 2012;12:52.

  • 28. Çukurova S Pamuk ÖN Ünlü E et al. Subclinical atherosclerosis in gouty arthritis patients: a comparative study. Rheumatol Int. 2012; 32(6):1769-73.

  • 29. Montalcini T Gorgone G Gazzaruso C et al. Relation between serum uric acid and carotid intima-meida thickness in healthy postmenopausal women. Intern Emerg Med. 2007; 2(1):19-23.

  • 30. Tavil Y Kaya MG Oktar SO et al. Uric acid level and its association with intima-media thickness in patients with hypertension. Atherosclerosis. 2008; 197(1):159-163.

  • 31. Miao Z Yan S Wang J et al. Insulin resistance acts as an independent risk factor exacerbating high-purine diet induced renal injury and knee joint gouty lesions. Inflamm Res. 2009; 58(10):659-68.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 154 154 16
PDF Downloads 115 115 5