Dr. Mikuls emphasized that effective treatment and prevention of gout requires attention. “I think gout is often thought of incorrectly as a one-visit encounter for providers, a mindset that we really need to get away from, particularly in our gout patients with chronic comorbid illnesses,” he said.
Hyperuricemia a Potential Marker
A growing body of evidence suggests a role for the use of hyperuricemia as a potential marker predictive of people at increased risk for cardiovascular disease, according to Eswar Krishnan, MD, assistant professor of medicine, in the division of immunology and rheumatology at Stanford School of Medicine in Stanford, Calif. Although a causal relationship between hyperuricemia and cardiovascular disease remains under debate, Dr. Krishnan said that even without established causality, the long recognized association between high uric acid and cardiovascular disease can provide clinicians with some useful information in assessing cardiovascular risk.
In his presentation, Dr. Krishnan suggested that testing uric acid levels in a patient with other risk factors for cardiovascular disease may be an easy and cost-effective way of further predicting which patients are truly at risk. Although he said the contribution may be only minor in helping to predict cardiovascular disease risk beyond the major contributions made by clinical history (e.g., age, sex, body mass index, hypertension and smoking status, and family history of heart attacks), and that a lipid profile would be the best test for predictability after clinical history, he suggested that checking uric acid levels may be the next best test to improve the predictability of cardiovascular disease.
Dr. Krishnan’s evidence for this approach comes from two metrics he used to assess the predictive value of uric acid for cardiovascular disease. Using the integrated discrimination improvement and net reclassification improvement metrics, two metrics used to see if a new candidate risk marker adds to existing risk prediction models, he found that uric acid levels were seen as a better predictive test for cardiovascular risk compared with creatinine levels. This suggests to him that high uric acid levels may be as least as valuable as knowing whether a patient has kidney disease.
He also said that this would be highly cost effective, with a uric acid test typically costing around $10 compared to, for example, the more expensive C-reactive protein test currently used in this setting.
Currently, Dr. Krishnan said, the U.S. Preventive Services Task Force has not commented on hyperuricemia as a risk factor for cardiovascular assessment and takes the position that the evidence is currently insufficient to assess the benefits and harms of using nontraditional risk factors to predict coronary heart disease.2
