title: Gout and rheumatoid arthritis, both to keep in mind in cardiovascular risk management: A primary care retrospective cohort study.
abstract: OBJECTIVE
  To assess in one time window cardiovascular risks for both patients with gout and patients with rheumatoid arthritis in a Dutch primary care population.
  
  
  METHODS
  Retrospective matched cohort study with data from the electronic health records of 51 Dutch general practices. Participants were patients aged 30 years or older with an incident diagnosis of gout (n=2655) or rheumatoid arthritis (n=513), and matched non-disease controls (n=7891 and n=1850 respectively). At disease incidence date, patients and controls were compared for prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and prior cardiovascular diseases. Patients without prior cardiovascular disease were followed for a first cardiovascular disease, and compared to controls using Kaplan-Meier survival curves and Cox proportional hazard analyses.
  
  
  RESULTS
  Compared to controls, gout patients suffered more from hypertension (44.8%), diabetes (20.1%), hypercholesterolemia (13.7%), and prior cardiovascular disease (30%) (P<0.01), whereas rheumatoid arthritis patients (hypertension 28.5%; diabetes 11.7%; hypercholesterolemia 7.4%; prior cardiovascular disease 11.3%) did not (P>0.05). After adjustment, both gout and rheumatoid arthritis patients without prior cardiovascular disease were more likely to get a cardiovascular disease: hazard ratio (95% confidence interval) 1.44 (1.18 to 1.76), and 2.06 (1.34 to 3.16) respectively.
  
  
  CONCLUSIONS
  This primary care study indicates that gout and rheumatoid arthritis are both independent risk factors for cardiovascular diseases, rheumatoid arthritis to some greater extent, whereas gout patients at first diagnosis had already an increased cardiovascular risk profile. It gives strong arguments for implementation of both rheumatic diseases in primary care guidelines on cardiovascular risk management.
authors.affiliation: Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands; Primary health care center Lobede, Lobith-Tolkamer, The Netherlands. Electronic address: Hein.Janssens@radboudumc.nl.
authors.forename: Hein J E M
authors.initials: HJ
authors.lastname: Janssens
authors.affiliation: Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands.
authors.forename: Paul G J
authors.initials: PG
authors.lastname: Arts
authors.affiliation: Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands.
authors.forename: Bianca W M
authors.initials: BW
authors.lastname: Schalk
authors.affiliation: Department of primary and community care, Radboud university medical center, PO Box 9101, Internal code 117, 6500 HB Nijmegen, The Netherlands.
authors.forename: Marion C J
authors.initials: MC
authors.lastname: Biermans
mesh_terms: D017677:Age Distribution; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology / Q000503:physiopathology; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate
keywords: Cardiovascular diseases; Cohort study; Gout; Primary health care; Primary prevention; Rheumatoid arthritis