Association Between Urate-Lowering Therapy and Prevalence of Comorbidities Studied in Gout

Urate-lowering therapy (ULT) may have may have additional benefits, apart from lowering serum urate levels, in patients with gout, noted the authors of a study published in Rheumato.

Gout is associated with elevated risk for other chronic conditions, including diabetes and cardiovascular disease.

The effect of ULT on the prevalence of chronic conditions, including heart disease, hyperlipidemia, hypertension, and chronic kidney disease, was studied.

Researchers from Nova Southeastern University College of Pharmacy in the US collected data from the National Health and Nutrition Examination Survey (NHANES). Adults aged at least 30 years with gout who responded to the NHANES survey between 2013 and 2014, 2015 and 2016, or 2017 and 2018 were included in the study.

A total of 245 patients with gout received ULT (mean age, 65 years; 75.8% men; 69.8% White) and 590 did not (mean age, 61 years; 63.8% men; 70.1% White). Patients who received and did not receive ULT were diagnosed with gout 13.5 and 14.6 years previously, respectively.

In the crude analysis, use of ULT was not associated with comorbid type 2 diabetes (odds ratio [OR], 1.22; 95% CI, 0.684-2.19), heart failure (OR, 1.56; 95% CI, 0.834-2.93), coronary heart disease (OR, 1.25; 95% CI, 0.69-2.26), high cholesterol (OR, 1.09; 95% CI, 0.66-1.80), and high blood pressure (OR, 1.50; 95% CI, 0.811-2.78). Comorbid chronic kidney disease was related with ULT use, even after adjusting for covariates (adjusted OR [aOR], 2.35; 95% CI, 1.07-4.31).

Use of ULT was favorably associated with low-density lipoprotein cholesterol (adjusted b, 11.96; P =.032), total cholesterol (adjusted b, 10.95; P =.038), and C-reactive protein (CRP; adjusted b, 2.46; P =.044) levels.

Researchers noted that ULT did not appear to affect glycohemoglobin, high-density lipoprotein cholesterol, and triglyceride levels, systolic and diastolic blood pressure, and estimated glomerular filtration rate.

Study limitations included the cross-sectional design and the lack of evaluation of causal relationships.

The study authors concluded, “Despite participants receiving ULT being more likely to be overweight or obese when compared to those not receiving ULT, lower lipid levels among those receiving ULT were seen. Additionally, lower CRP levels were observed in those receiving ULT compared to those not receiving ULT. Patients [with gout] receiving ULT may garner added health benefits beyond lower urate levels.”