Cardiovascular disease risk factor assessment and management in gout: an analysis using guideline-based electronic clinical decision support.
OBJECTIVE
To assess the need for cardiovascular disease (CVD) risk management in patients with gout.


METHODS
We studied 100 consecutive patients referred to the rheumatology service for management of gout. CVD risk factor and management data were collected. PREDICT CVD decision support software was used to calculate Framingham 5-year CVD risk, and to analyse therapeutic targets.


RESULTS
Fifty-nine (59%) patients had a high (>15%) or very high (> or = 20%) 5-year CVD risk. For those at high risk of CVD, target systolic blood pressure was achieved in 34%; target LDL-cholesterol in 49%, target HDL-cholesterol in 56%; and 81% did not smoke. For patients with diabetes, target HbA1c was reached in 40%. For high-risk individuals only 50% of eligible patients were on aspirin, 64% on beta-blockers, 53% statins, and 65% ACE inhibitors. There were no significant differences in duration of gout, presence of tophaceous disease, use of urate-lowering therapy or C-reactive protein between patients at high risk of CVD, and those with lower risk.


CONCLUSIONS
Patients with gout referred to secondary care are at high risk for CVD, and have a large burden of modifiable risk factors. Implementation of CVD screening and management programs in these patients should have high therapeutic yield.
Colvine
Keith
K
Department of Medicine, North Shore Hospital, Shakespeare Road, Private Bag 93-503, Takapuna, Auckland, New Zealand. keith.colvine@waitematadhb.govt.nz
Kerr
Andrew J
AJ
McLachlan
Andrew
A
Gow
Peter
P
Kumar
Sunil
S
Ly
Jason
J
Wiltshire
Chris
C
Robinson
Elizabeth
E
Dalbeth
Nicola
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000145:classification* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D005260:Female; D006073:Gout / Q000150:complications* / Q000188:drug therapy; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications* / Q000188:drug therapy; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods*
D000959:Antihypertensive Agents; D006074:Gout Suppressants