title: Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment.
abstract: OBJECTIVE
  Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk.
  
  
  METHODS
  Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves.
  
  
  RESULTS
  237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS.
  
  
  CONCLUSIONS
  The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout.
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain.|Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Mariano
authors.identifier: http://orcid.org/0000-0002-0219-9055
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Bernal
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain.
authors.forename: Neus
authors.initials: N
authors.lastname: Quilis
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Loreto
authors.identifier: http://orcid.org/0000-0002-4401-2551
authors.initials: L
authors.lastname: Carmona
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain.|Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela
authors.affiliation: Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain.|Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Pascual
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D019540:Area Under Curve; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006073:Gout / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012219:Rheumatology; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography
keywords: Atherosclerosis; Cardiovascular Disease; Gout; Ultrasonography