Dyslipidemia, Alcohol Consumption, and Obesity as Main Factors Associated With Poor Control of Urate Levels in Patients Receiving Urate‐Lowering Therapy

摘要

Objective In real life, in a substantial proportion of gouty patients receiving urate‐lowering therapy ( ULT ), urate levels are not maintained below the target of 6.0 mg/dl. We aimed to search for factors associated with poor control of serum uric acid ( UA ) levels in a large population of patients with gout receiving ULT . Methods This cross‐sectional study involved adults with gout in primary care who were receiving ULT . Demographics, gout history, comorbidities, lifestyle, clinical factors, concomitant treatments, and laboratory data were compared in well‐controlled gout (serum UA ≤6.0 mg/dl) versus poorly controlled gout (serum UA 6.0 mg/dl) on univariate and multivariate analyses. Results Among the 1,995 patients receiving ULT , only 445 (22.3%) had reached the target of 6.0 mg/dl serum UA . Such patients had a lower rate of gout flares within the previous year than patients without the target (mean ± SD 1.7 ± 1.4 versus 2.1 ± 1.4; P 0.0001). The main factors associated with poor serum UA level control in multivariate analysis were low high‐density lipoprotein cholesterol level (adjusted odds ratio [OR] 0.5 [95% confidence interval (95% CI ) 0.26–0.96]; P = 0.04), high total cholesterol level ( OR 1.83 [95% CI 1.29–2.60]; P = 0.0007), increased waist circumference ( OR 1.55 [95% CI 1.11–2.13]; P = 0.008), and alcohol consumption ( OR 1.52 [95% CI 1.15–2.00]; P = 0.003). Conclusion Dyslipidemia, abdominal obesity, and alcohol consumption are the main factors associated with a poor response to ULT . Knowledge of these factors might help physicians identify cases of gout that may be less likely to achieve target urate level.