Tophi and Carotid Atherosclerosis in Gout patients: Role of Insulin Resistance

Objective: Gout and cardiovascular disease are closely related, but the mechanism linking them is still unknown. Gout may affect the insulin signalling pathway inducing insulin resistance (IR). The study aims to evaluate the association between tophi and carotid atherosclerosis, considering the potential role of IR. Methods: A total of 595 patients with gout aged 18 to 80 were enrolled in this study. Carotid intima-media thickness, plaques and tophi were evaluated by B-mode ultrasonography. IR was assessed by the HOMA index (hepatic IR) and Gutt index (peripheral IR). Multivariable logistic regression and interaction analysis were used to examine the the accociation between tophi and IR and its impact on carotid atherosclerosis. Results: Among these participants, the average age was 55.4 (± 12.54) years, and 94.6% were male. Tophi were associated with increased odds of carotid atherosclerosis and burden after adjustment for confounders (P < 0.05). Tophi and IR synergically interacted for inducing carotid atherosclerosis. And the interaction between peripheral IR with tophi was more pronounced than hepatic IR with tophi. Conclusions: Tophi were independently associated with carotid atherosclerosis risk. IR mediated a significant amount of the effect of tophi on the development of carotid atherosclerosis. Peripheral IR probably plays a more important role than hepatic IR does.