The lack of association between the burden of monosodium urate crystals assessed with dual-energy computed tomography or ultrasonography with cardiovascular risk in the commonly high-risk gout patient

Background: Gout is associated with higher cardiovascular risk that increases with disease severity. The objective of this study was to explore the relationship between the extent of monosodium urate (MSU) crystal deposition, assessed with ultrasonography (US) and dual-energy computed tomography (DECT), and cardiovascular risk. Methods: Gout patients were included in this cross-sectional study to undergo DECT scans for the assessment of total MSU volume deposition in the knees and feet, and US to evaluate the number of joints with the double contour (DC) sign. Participants were screened for traditional cardiovascular risk factors, and levels of the American College of Cardiology (ACC)/American Heart Association (AHA) 10-year risk for heart disease or stroke were calculated. The primary endpoint was the Spearman correlation coefficient p between DECT MSU volume and cardiovascular risk. Results: A total of 42 patients were included; they were predominantly male (40/42) and aged 63.0 +/- 13.2 years. Overall, 28/42 patients presented with the metabolic syndrome and the average 10-year coronary event or stroke risk according to the ACC/AHA (n = 33) was 21 +/- 15%. Correlations between DECT volumes of MSU deposits in the knees, feet, and knees + feet and cardiovascular risk according to the ACC/AHA were very poor, with p = 0.18, -0.01, and 0.13, respectively. The was no correlation between the number of joints with the DC sign and cardiovascular risk (p = -0.07). DECT MSU deposit volume was similar in patients with and without metabolic syndrome (p = 0.29). Conclusions: The extent of MSU burden does not increase the estimated risk of cardiovascular events in gout patients.