UAB Internal Medicine Residency Birmingham, Alabama, United States
Disclosure(s): No financial relationships with ineligible companies to disclose
Background/Purpose: Gout is associated with a 50% increased risk of cardiovascular disease (CVD).1 The current recommendation for evaluating CVD risk in gout is to use prediction tools developed in the general population.2 Studies have shown that CVD risk assessment tools underestimate CVD in people with gout.3 The Predicting Risk of cardiovascular disease EVENTs (PREVENT) calculator is a newly developed CVD risk predictor that is the first to combine multiple organ systems and social determinants of health.4 Whether the PREVENT calculator improves prediction of atherosclerotic CVD in patients with gout is unknown. Our aim is to assess the performance of the PREVENT calculator in detecting coronary plaque in patients with gout, against gold standard coronary artery calcium (CAC) testing, a CT-based technique to detect subclinical coronary atherosclerosis.5 Methods: We identified adult patients with gout seen in the University of Alabama at Birmingham clinics from 2016-2024. Patients were excluded if they were missing variables needed to calculate PREVENT or missing CAC score. High CVD risk was defined as having a PREVENT score of > 7.5%10-year total CVD risk or a CAC score > 0.4,5 Baseline variables were collected at time of CAC score. To assess the discriminative value of PREVENT in detecting coronary plaque, a 2x2 table was created to match high risk PREVENT scores vs high risk CAC scores. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated with their 95% confidence intervals (CI).
Results: 69 patients with gout were eligible for the study. The mean age was 61.4 years, 18 patients were female, 59 patients were White (see Table 1 for other demographics). 65.2% of patients had a high CAC score; 31.9% of patients had a high PREVENT score. The results (95% CI) for sensitivity, specificity, positive, and negative predictive values were 40.0% (25.7–55.7%), 83.3% (62.6–95.3%), 81.8% (63.2–92.2%), and 42.6% (35.5–50.0%), respectively. Conclusion: The PREVENT score is an inaccurate tool to predict presence of coronary atherosclerosis in patients with gout, being insensitive at identifying individuals with coronary plaque. Like prior calculators, the absence of inflammatory and disease-specific markers in risk tools may limit their discriminative value. Future studies should continue searching for better predictive tools for CVD risk in patients with gout.
References
1. Ferguson LD et al. Lancet Rheumatol. 2024;6:e156.
2. Andres M et al. Ann Rheum Dis. 2017;76:1263
3. Drosos GC et al.. Ann Rheum Dis. 2022;8:768
4. Khan SS et al. Circulation. 2024;149:430
5. McBride CB et al. Curr Cardiovasc Imaging Rep. 2013;6:211
