# The Prevalence and Associated Risk Factors of Coronary Heart Disease in Patients With Gout: A Cross-Sectional Study

## TL;DR

This study finds that 40% of gout patients have coronary heart disease, with hypertension and diabetes being major risk factors.

## Contribution

The study identifies specific risk factors for CHD in gout patients using logistic regression analysis in a Pakistani population.

## Key findings

- 40% of gout patients had CHD, with myocardial infarction being the most common.
- Hypertension, T2DM, and high cholesterol were significant predictors of CHD in gout patients.
- Intraosseous tophi and intermittent allopurinol intake were also linked to increased CHD risk.

## Abstract

Background

Long-term gout patients have been linked to increased risk of coronary heart disease (CHD) and its associated comorbidities. Therefore, careful evaluations are necessary to examine the prevalence and the causes of CHD in gout patients. The aim of this research was to identify significant factors associated with CHD in patients with gout along with the prevalence rate.

Materials and methods

A cross-sectional study was performed on 270 gout patients who attended the specialist outpatient clinic and the medicine department of Sheikh Zayed Medical College & Hospital, Rahim Yar Khan, Pakistan. Data about predictor variables was collected through interviews and standard clinical procedures. Blood samples were taken to measure laboratory variables such as fasting blood sugar (FBS), serum creatinine, cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Initially, descriptive statistics along with the chi-square test of association was executed. Finally, logistic regression analysis was performed as a classification method to estimate the odds ratio and confidence interval.

Results

The findings showed that 108 (40%, n=270) of gout patients experienced CHD with the highest prevalence rate (52; 48%, n1=108) of myocardial infarction (MI). Among all (n=270) patients, 150 (56%) were suffering from gout for more than 10 years, and 161 (60%) were diagnosed with hypertension. Considering p-value<0.05 as significant for the chi-square test, hypertension (p-value=0.001), type 2 diabetes mellitus (T2DM) (p-value=0.004), family history of CHD (p-value=0.001), serum creatinine (p-value=0.02), cholesterol (p-value=0.04), subcutaneous tophi (p-value=0.02), intraosseous tophi (p-value=0.04), and intermittent allopurinol intake (p-value=0.04) were found to be associated with CHD in patients with gout. The logistic regression analysis showed that hypertension (OR=2.70, CI: 1.60-4.58), T2DM (OR=2.08, CI: 1.26-3.42), creatinine (OR=1.77, CI: 1.07-2.93), cholesterol (OR=1.67, CI: 1.02-2.73), HDL-C (OR=0.59, CI: 0.36-0.96), subcutaneous tophi (OR=1.86, CI: 1.09-3.16), intraosseous tophi (OR=2.22, CI: 1.29-3.81), and intermittent allopurinol consumption (OR=1.92, CI: 1.01-3.66) were associated with CHD in patients with gout.

Conclusions

The study estimated that 40% of patients with chronic gout developed different types of CHD with the highest prevalence of MI, regardless of the duration of gout or treatment of acute attacks. Hypertension, T2DM, obesity, high creatinine, high cholesterol, low HDL-C and presence of intraosseous tophi are found to be significant factors of CHD in gout patients. These findings significantly contributed to medical research to address the risk of CHD among Pakistani patients with gout by controlling these significant associated factors. Gout patients with a positive family history of CHD should also take precautionary measures to avoid heart complications. Nation-wide large-scale analyses considering rural/urban disparities are recommended for more in-depth investigations of influencing factors to prevent cardiovascular complications among patients with gout since diversity in demographic, lifestyle and environmental factors may influence the overall impact. Future analysis with lipids as a continuous variable is also suggested for more accurate estimates.