Gout tied to higher risk of heart disease mortality

NEW YORK (Reuters Health) - For men with risk factors for heart disease, having the arthritic condition gout may further boost their odds of dying from heart problems, a study suggests.

Researchers found that among 9,100 middle-aged men at higher-than- average risk of heart disease, those with gout were more likely to die of a heart attack or other cardiovascular cause over 17 years.

The findings should give men with gout extra incentive to have a doctor assess their cardiac risks, lead researcher Dr. Eswar Krishnan told Reuters Health.

And if they have modifiable risk factors -- like high cholesterol, high blood pressure or excess pounds -- it will be particularly important to get them under control, noted Krishnan, an assistant professor at Stanford University School of Medicine.

He and his colleagues report the findings in the Archives of Internal Medicine.

Gout is a very painful form of arthritis that causes the joints to periodically become swollen, red and hot -- most often affecting the big toe, though it also strikes the feet, ankles, knees, hands and wrists.

Gout arises when uric acid crystals build up in the joints. The body produces uric acid when it breaks down purines -- substances found naturally in the body, but also in certain foods, like organ meats, anchovies, mushrooms and some seafood, such as herring and mackerel.

Some research has linked high uric acid levels in the body to a higher risk of cardiovascular trouble. Similarly, studies have found that men with gout have higher-than-average rates of heart attack and angina -- chest pain caused by insufficient blood flow to the heart.

The current study involved 9,105 men between the ages of 41 and 63 who were at elevated risk of heart disease due to smoking, high cholesterol and/or high blood pressure.

Those who also had gout, the researchers found, were one third more likely to die of coronary heart disease over 17 years. They also had a higher risk of dying from any cardiovascular cause, such as stroke.

Controlling cardiovascular risk factors through diet, exercise, weight loss and medication is important for everyone, Krishnan noted.

But people with gout can reap the added benefit of improved joint symptoms, he said; losing excess pounds and eating a healthful diet low in purines, for instance, could help cut uric acid levels and prevent gout attacks.

It's not entirely clear why gout is linked to heart disease death.

Excess uric acid in the body can create oxidative stress, a state that damages body cells and contributes to diseases, including the buildup of artery-clogging plaques.

But Krishnan said that factors other than uric acid, such as widespread inflammation in the body, may be involved as well.

Not everyone with high uric acid levels develops gout, the researchers note; and in this study, men who fell into this category did not have higher odds of dying from heart disease.

SOURCE: Archives of Internal Medicine, May 26, 2008.