Family History, SUA Levels Indicate LV Diastolic Insufficiency in Gout

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A strong association between a family history of gout and echocardiographic left ventricular (LV) diastolic function parameters was observed among a cohort of Chinese patients, according to a study published in International Journal of General Medicine.¹ Additionally, combining a family history of this condition with serum uric acid (SUA) levels was shown to be a valuable indicator for the identification of grade ≥ 2 LV diagnostic insufficiency among this patient population.

Genetics have been proven to play a crucial role in the pathogenesis of gout, with approximately 20% of patients reported to have a family history of the condition. Additionally, the magnitude of risk has been shown to increase with increasing genetic relatedness, with the highest risk reported in patients with > 1 affected first-degree relatives.²

“Given that both genetic factors and inflammatory component contributed to the complex mechanism of gout pathogenesis, it may be possible that these factors influence cardiac dysfunction,” wrote a group of Chinese investigators. “Individuals with a family history of gout may yield a greater impact on cardiac insufficiency compared to non-genetically predisposed persons. However, to the best of our knowledge, no such study has so far been conducted.”

Investigators used echocardiography to measure the markers of LV diastolic function to determine the effects of family history in patients with gout. They enrolled patients with gout who visited the Department of Rheumatology and Immunology of the First Affiliated Hospital of Chengdu Medical College between September 2020 and July 2022. Data including a family history of gout, laboratory markers, and general information were collected. Multivariate and univariate regression were used to find any correlation between family history and LV diastolic function.

A total of 284 patients with gout were recruited into the study. Among patients with gout, LV diastolic function parameters, peak early mitral diastolic velocity (E)/peak late mitral diastolic velocity (A), and early septal mitral annulus diastolic motion velocity (Sepe’), early lateral mitral annulus diastolic motion velocity (Late’) and their mean (e’), were significantly lower. Conversely, left atrial volume index (LAVI) and E/e’ were significantly elevated in patients with sporadic primary gout.

For those with a family history of gout, the proportion of grade ≥ 2 LV diastolic insufficiency was markedly higher compared with patients without family history (41.6% vs 12.3%, respectively). After adjusting for confounding variables, LAVI, Sepe’, Late’, e’, E/e’, and E/A were still significantly associated with a family history of gout.

The area under the receiver operating characteristic (ROC) of family history in combination with SUA level for classifying grade ≥ 2 LV diastolic insufficiency in patients with gout was .872 (P <.05).

Investigators noted limitations including the cross-sectional nature of the study design which is unable to determine the causality of the occurrence and progression of diseases. Additionally, the single-center study was constricted to a regional population. Although some diseases that can be attributed to LV diastolic insufficiency were excluded, certain factors may not have been considered. Future studies should focus on newer technologies and integrated use of multiple echocardiographic techniques.

“A combination of family history and SUA level in patients with gout had a better identification performance,” investigators concluded. “Early clinical determination and intervention of LV diastolic insufficiency can be achieved by asking patients with gout if they have family history of gout.”

References

1. ^{Wen W, Lei P, Dang W, Ma L, Hu J, Liu J. Association Between Family History in Patients with Primary Gout and Left Ventricular Diastolic Function: A Cross-Sectional Study. Int J Gen Med. 2024;17:1311-1322. Published 2024 Apr 3. doi:10.2147/IJGM.S450951}
2. ^{Kim KH, Choi IA, Kim HJ, et al. Familial risk of gout and interaction with obesity and alcohol consumption: a population-based cohort study in Korea[J]. Arthritis Care Res. 2023;75(9):1955–1966. doi:10.1002/acr.25095}