Can gout increase the risk of heart attack?

Gout is a metabolic form of arthritis marked by acute joint inflammation, usually starting in the knee or foot. It is caused by hyperuricemia, a build up of uric acid in blood. When chronic or severe, hyperuricemia leads to deposits of monosodium urate crystals within joints resulting in gouty arthritis.

A recent study has demonstrated that gout is an independent risk factor for heart attack.

The principal author, Eswar Krishnan, MD, assistant professor of medicine at the University of Pittsburgh School of Medicine states, "Our study confirms that gouty arthritis is an independent risk factor for myocardial infarction (MI) or heart attack. Until now this relationship has not been explained by well-known links to renal function, metabolic syndrome, diuretic use and the traditional cardiovascular risk factors."

The prospective study examined data from 12,866 men who were enrolled for a mean of 6.5 years in the Multiple Risk Factor Intervention Trial (MRFIT), a randomized primary cardiovascular disease prevention trial conducted and supported by the National Heart, Lung and Blood Institute.

There were 5,337 men with hyperuricemia at the beginning of the study. Over the study period, 1,123 individuals developed gouty arthritis. There was no statistically significant difference between the groups with regard to cholesterol levels, aspirin use, family history of acute MI, or diabetes mellitus. However, the group with gout was significantly more likely to have used diuretics and alcohol. Modest yet statistically significant elevations of blood pressure, age, blood glucose and body mass index were observed in the gout group. Subjects in the group with gout were less likely to be current smokers than were those in the group without gout.

During the course of the study, 1,108 events of acute heart attacks occurred in the group with gout (10.5 percent) and 990 events in the group without gout (8.43 percent). Of the 1,108 heart attacks, 246 were fatal.

The study also found a relationship between gout and the risk of acute heart attack to be present among nonusers of alcohol, diuretics or aspirin and among those who did not have diabetes mellitus or obesity.

Dr. Krishnan added, "The absolute magnitude of the relative risk for the presence of gout was not high. Yet, the odds ratio associated with gout was relatively high compared to other risk factors in this study."

He concludes, "For acute MI to occur, an environment that promotes atherogenesis and thrombogenesis is needed. 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."

 [Krishnan E, Baker JF, Furst DE, Schumacher HR. Gout and the risk of acute myocardial infarction. Arthritis Rheum 2006; 54 (8): 2688-2696].

Note: This story has been adapted from a news release issued by University of Pittsburgh Medical Center.

Author’s note: It’s not enough that gout is a painful type of arthritis to have and that it adversely affects kidney function.  People with multiple metabolic abnormalities including those with diabetes, elevated cholesterol and triglycerides, hypertension, and obesity are at increased risk for developing gout. Many of these patients are at increased risk for heart attack as well.  Now comes along a study indicating that gout is an independent risk factor by itself for heart attack.  This means that patients with gout need to have aggressive treatment given for their disease.