Gout and Cardiovascular Disease

A study reported in the Archives of Internal Medicine, May 26, 2008, indicated that middle-aged men with gout and elevated uric acid levels have an increased risk for cardiovascular disease (CVD) mortality.

Gout - Risk for CVD

Eswar Krishnan, MD, MPH, from the University Of Pittsburgh School Of Medicine in Pittsburgh, Pennsylvania, writes, "The Framingham Heart Study Group found an association between gout, unrelated to diuretic use, and coronary heart disease, primarily angina pectoris. During the intervention phase of the Multiple Risk Factor Intervention Trail (MRFIT), gout was associated with an increased risk of nonfatal acute myocardial infarction (MI) but not with an increased risk of fatal acute MI."

For those with gout, the risk for CVD mortality was about 30 percent higher than for those without gout, even after adjustment for expected risk factors, using diuretics and aspirin and serum creatinine levels. "Among middle-aged men, a diagnosis of gout accompanied by an elevated uric acid level imparts significant independent CVD mortality risk," the authors of the study wrote.

The Connection is Made

Gouty arthritis is a common condition in which there are flare-ups of inflammation and pain caused by hyperuricemia, or the high level of uric acid crystals which collect in the joints and tissues. Over the years, rheumatologists have generally agreed that the major effects of high levels of uric acid were kidney stones and gout. The association with heart disease was acknowledged but the assumption was that the hyperuricemia was caused by gout, renal disease or hypertension. Until recently, most medical reviews have concluded that hyperuricemia is benign unless it is associated with gout or kidney stones.

Independent Risk Factor

However, the study done by Dr. Krishnan and associates, which involved over 12,000 men over a period of 6.5 years, discovered a distinct relationship between gout and the risk of acute myocardial infarction even among nonusers of alcohol, diuretics or aspirin and those who did not have any metabolic syndromes, diabetes or obesity issues. Dr. Krishan continues, " Hyperuricemia is well known to be an independent risk factor for atherosclerotic diseases in general and since chronic hyperuricemia is strongly associated with gout, it is not very surprising that an independent coronary risk for the presence of both hyperuricemia and gout was observed."

More Research for Understanding

At the end of it all, the study suggests that gout is an independent risk factor for death from cardiovascular disease; however, how to modify this risk is not known. Continued research is necessary to understand exactly how gout contributes to cardiovascular mortality before efforts can be made to address the risk. Between here and there, the obvious needs to be restated: reduce alcohol and fructose intake, maintain a healthy lifestyle, stay active and take the necessary precautions to guard your health.