In a groundbreaking study recently published in ‘Nutrition, Metabolism, and Cardiovascular Diseases’ (NMCD), researchers focused on elucidating the relationship between gout, a condition characterized by painful uric acid crystal deposits known as tophi, and its association with carotid atherosclerosis, considering the potential impact of insulin resistance (IR). The findings from this work, spearheaded by Si Ke, Chi Jingwei, Xu Lili, Dong Bingzi, Huang Yajing, Zhang Haowen, Chen Ying, and Wang Yangang from the Department of Endocrinology at the Affiliated Hospital of Qingdao University, highlight the significance of metabolic factors in the pathogenesis of cardiovascular disease among gout patients.

The Study

The study, entitled “Tophi and carotid atherosclerosis in gout patients: Role of insulin resistance,” involved a cohort of 595 gout patients ranging in age from 18 to 80 years. The vast majority of the participants (94.6%) were male, reflecting the higher prevalence of gout in the male population. Researchers employed B-mode ultrasonography to evaluate the presence of carotid atherosclerosis, measuring carotid intima-media thickness and the presence of plaques and tophi, while IR was assessed using the Homeostatic Model Assessment (HOMA) index for hepatic IR and the Gutt index for peripheral IR.

Key Findings

Multivariable logistic regression and interaction analysis revealed that the presence of tophi was associated with increased odds of carotid atherosclerosis even after adjusting for various confounders. The study also discovered a significant interaction between tophi and IR, suggesting that these factors may synergize to increase the risk of carotid atherosclerosis. Specifically, the impact of peripheral IR in the presence of tophi was more pronounced than that of hepatic IR. The researchers concluded that IR significantly mediates the effect of tophi on the progression of carotid atherosclerosis and that peripheral IR likely plays a more crucial role than hepatic IR.

Implications and Future Directions

This study sheds light on the complex interplay between metabolic disturbances and cardiovascular risk in patients with gout. Understanding the relationship between tophi, IR, and carotid atherosclerosis opens up new avenues for therapeutic intervention and risk assessment in this patient population. The findings underscore the need for comprehensive management strategies that address not only the classic symptoms of gout but also the associated metabolic and cardiovascular risks.


This research marks a critical step forward in the quest to unravel the connections between gout, IR, and cardiovascular disease. The team’s efforts to detail the relationships between tophi deposition, the varying impacts of hepatic and peripheral IR, and the development of carotid atherosclerosis present a comprehensive model that could enhance current approaches to treating gout and preventing its cardiovascular complications.

As such, the article “Tophi and carotid atherosclerosis in gout patients: Role of insulin resistance,” with its DOI 10.1016/j.numecd.2023.11.019, becomes a cornerstone reference for clinicians and scientists aiming to mitigate the cardiovascular risks inherent to gout. It lays the groundwork for future investigations that may lead to novel therapeutic strategies targeting metabolic dysfunctions in gout, with potential benefits extending to a range of interrelated conditions.


1. Si, K., Jingwei, C., Lili, X., Bingzi, D., Yajing, H., Haowen, Z., Ying, C., & Yangang, W. (2023). Tophi and carotid atherosclerosis in gout patients: Role of insulin resistance. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, S0939-4753(23)00481-7.

2. Dalbeth, N., & Merriman, T. R. (2019). Gout and the Heart. Rheumatology (Oxford, England), 58(1), 29–38.

3. Feig, D. I., Kang, D. H., & Johnson, R. J. (2008). Uric acid and cardiovascular risk. New England Journal of Medicine, 359(17), 1811–1821.

4. Grundy, S. M. (2008). Metabolic syndrome pandemic. Arteriosclerosis, Thrombosis, and Vascular Biology, 28(4), 629–636.

5. Pfeifle, B., Ditschuneit, H. (1981). Effect of insulin on growth of cultured human arterial smooth muscle cells. Diabetologia, 20(2), 155–158.


1. Gout and Atherosclerosis
2. Insulin Resistance in Gout
3. Carotid Intima-Media Thickness
4. Gout Tophi and Cardiovascular Risk
5. Metabolic Syndrome and Gout