Cardiovascular disease risk factor assessment and management in gout: an analysis using guideline-based electronic clinical decision support.

Abstract

AIM:

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.

• Authors: Keith Colvine, Andrew J Kerr, Andrew McLachlan, Peter Gow, Sunil Kumar, Jason Ly, Chris Wiltshire, Elizabeth Robinson, Nicola Dalbeth
• Journal: The New Zealand medical journal (N Z Med J) Vol. 121 Issue 1285 Pg. 73-81 (Nov 07 2008) ISSN: 1175-8716 [Electronic] New Zealand
• PMID: 19079439 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Antihypertensive Agents
• Gout Suppressants

Topics

• Adult
• Aged
• Aged, 80 and over
• Antihypertensive Agents (classification, therapeutic use)
• Cardiovascular Diseases (etiology)
• Decision Support Systems, Clinical (organization & administration)
• Female
• Gout (complications, drug therapy)
• Gout Suppressants (therapeutic use)
• Humans
• Hypercholesterolemia (complications, drug therapy)
• Hypertension (complications, drug therapy)
• Male
• Metabolic Syndrome (etiology)
• Middle Aged
• Practice Guidelines as Topic
• Risk Assessment (methods)