The heartbeat of gout: The relationship between gout and cardiovascular disease and its management

Patients with gout are a high risk population regarding development of CVD. This is partly explained by high prevalence of traditional CV risk factors and partly by gout as independent CV risk factor. The pathophysiological link with CVD is not fully elucidated, however inflammation and especially activation of neutrophils and activation of the coagulation system are involved mechanisms. Levels of NETs and neutrophil activation markers as myeloperoxidase and calprotectin are elevated in patients with gout in comparison with healthy controls and neutrophil activation markers are potential biomarkers in monitoring gout disease activity. These results should be validated in other and larger gout cohorts. Furthermore, myeloperoxidase and calprotectin levels are associated with high 10-year risk of CVD. However, due to the lack of a control group with similar traditional CV risk factors in our study, the causal role of gout remains uncertain. Beside atherosclerotic CVD, patients with gout have an increased risk of VTE. In this thesis we found associations between gout disease activity and thrombin generation which is the first step in explaining the increased risk of VTE. Besides gout related CV risk factors, this thesis emphasized the high prevalence of traditional CV risk factors in gout patients and showed that CV risk management in this population is performed poorly. Recommendations given to the patients on lifestyle and GP visits often had no follow up and did not result in a decrease in 10-year risk of CVD after one year. In between visits, prevalence of CVD increased from 18 to 21% and this highlights again the need of accurate CV risk management in this population. For gout patients in secondary care, CV risk management should be initiated by the rheumatologist.