Fasting Plasma Glucose Linked to Myocardial Dysfunction in Gout

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Elevated urea and fasting plasma glucose (FPG) were shown to be risk factors for subclinical left ventricular (LV) myocardial dysfunction in patients with gout, according to a study published in Frontiers in Physiology.¹ Investigators believe these results reinforce the need for early diagnosis and treatment of heart disease in this patient population.

Previous research has demonstrated the association between cardiovascular events and gout, although the relationship between these events and serum uric acid (sUA) requires further analysis. To better understand this connection, investigators noted studies must also take lifestyle, obesity, and insulin resistance into account.²

“In recent years, echocardiographic techniques have been rapidly developed as novel auxiliary techniques for assessing the structure and function of the heart,” a group of Chinese investigators wrote. “One of which is speckle tracking, which is principally based on the analysis of speckles during the cardiac cycle, [and serves] as a powerful quantitative tool to assess global and regional LV function.”

Investigators recruited patients with gout, along with 51 healthy controls, who visited the inpatient and/or outpatient departments of the first affiliated hospital of Chengdu Medical College between November 2019 and December 2020. Eligible patients met the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout diagnosis criteria and had not received treatment to lower blood pressure, glucose, and uric acid within the previous 3 months. All participants were given 2-dimensional echocardiographic examinations at rest and investigators collected fasting blood, defined as no food or drink for ≥8 hours, in the morning on the day of the echocardiographic examination.

The correlation coefficients between laboratory data and echocardiographic parameters were evaluated using the Spearman correlation test, while logistic regression analysis determined independent effects.

In total, 227 cases were included in the analysis, of which 94.7% (n = 215) were male with an average age of 45.71 years. Among this cohort, 164 patients had decreased global longitudinal strain (GLS), 96 patients had decreased global circumferential strain (GCS), 20 had increased early diastolic tissue velocity (E/Em), 16 had left atrial volume index (LAVI), and 16 had left ventricular hypertrophy (LVH). No significant differences in body mass index (BMI), disease course, and age were observed between patients with GLS and GCS (P >.05).

Compared with controls, the absolute values of GCS and GLS were lower in patients with gout and E/Em and left ventricular mass index (LVMI) were larger. LAVI and left ventricular ejection fraction (LVEF) were comparable among both groups.

Multivariate logistic regression revealed FPG was a risk factor for reductions in absolute value of GLS (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.01 – 5.39; P = .04), while urea was a risk factor for absolute reduction in GCS (OR = 1.40; 95% CI, 1.07 – 1.85; P = .02). High urea levels were also significantly linked to higher risks of LVH (OR = 1.59, 95% CI, 1.04 – 2.43; P = .03) and enlargement of LAVI (OR = 1.68, 95% CI, 1.01 – 2.80; P = .04). Hypertension (OR = 8.35; 95% CI, 1.83 – 38.02; P = .006) and age (OR = 1.09, 95% CI, 1.04 – 1.16; P = .001) were connected to a higher risk for increased E/Em.

Investigators mentioned the single-center study and the small sample size as limitations, as they may introduce regional bias, hinder generalizability, and affect the reliability of results. Additionally, a small number of patients in this study were female, which may have impacted findings due to physiological differences. Data quality may have been an issue due to incomplete data records and inaccurate measurements.

“While caution must be taken in generalizing these findings to female patients due to potential gender differences in this study, they provide a valuable theoretical basis for the early diagnosis and treatment of heart disease in patients with gout in clinical practice,” investigators concluded. “Besides, older patients with gout and hypertension should be close monitored to prevent the occurrence of cardiovascular events.”

References

1. ^{Dang W, Luo D, Hu J, Luo H, Xu X, Liu J. Analysis of risk factors for changes of left ventricular function indexes in Chinese patients with gout by echocardiography. Front Physiol. 2023;14:1280178. Published 2023 Nov 23. doi:10.3389/fphys.2023.1280178}
2. ^{Maloberti A., Mengozzi A., Russo E., Cicero A. F. G., Angeli F., Agabiti Rosei E., et al. (2023). The results of the urrah (uric acid right for heart health) project: a focus on hyperuricemia in relation to cardiovascular and kidney disease and its role in metabolic dysregulation. High. Blood Press Cardiovasc Prev. 30, 411–425. doi:10.1007/s40292-023-00602-4}