Gout and Heart Disease News Roundup

Findings surrounding the possible role of gout as a risk factor for heart disease are mixed. The evidence for an association between inflammatory diseases such as rheumatoid arthritis and cardiovascular disease (CVD) is more robust, yet there are data that link hyperuricemia, the primary metabolic abnormality in gout, with higher risk of CVD. Elevated serum urate leads to acute joint inflammation and is associated with endothelial dysfunction, a known precursor to atherogenic disease. Hyperuricemia has also been identified as a risk factor for peripheral vascular disease, another manifestation of atherosclerosis.

The following short slide show reviews several recent studies that also suggest a link between the crystal-induced arthropathy and heart disease. What do you see in your practice?

Both High and Low Uric Acid Boost Cardiovascular Risk. A recent study evaluated relationships between serum uric acid level and newly emergent acute myocardial infarction, congestive heart failure, coronary artery disease, composite cardiovascular (CV) events, hypertension, hyperlipidemia, and renal disease in patients with gout. Both hyperuricemia and hypouricemia were linked with increased risk of CV events.

MI Risk is High in Gout and Other Arthritis. A systematic search was performed to evaluate the risk of incident myocardial infarction (MI) across 5 major types of arthritis. MI risk was significantly increased in gout, rheumatoid arthritis, psoriatic arthritis, and osteoarthritis and tended toward increased risk in ankylosing spondylitis. Traditional risk factors were more prevalent in all types of arthritis.

Uric Acid Level Runs Low With DASH Diet. The Dietary Approaches to Stop Hypertension (DASH) Diet, designed to lower high blood pressure, also may lower uric acid (UA) levels. The effect was greater among patients with hyperuricemia. In addition, higher sodium intake decreased serum UA levels.

Ketogenic Diet Douses Gout Flares. The low-carb, high-fat ketogenic diet prevents inflammation and joint pathology during gout flares. The ketone β-hydroxybutyrate, a known alternate metabolic fuel, is an anti-inflammatory molecule that may serve as a treatment for gout.

Putting Primary Care on the Gout Care Map. A new “roadmap” for improving gout care in all clinical practices calls on primary care to play a bigger role: “Major improvements in gout outcomes at a population level will require much deeper engagement of primary care and affiliated health professionals, and will require careful validation, particularly in populations with differing cultural and socioeconomic backgrounds.”

LINKS

Both High and Low Uric Acid Boost Cardiovascular Risk (J Clin Rheumatol)

MI Risk is High in Gout and Other Arthritis (Ann Rheum Dis)

Uric Acid Level Runs Low With DASH Diet (Arthritis Rheumatol)

Ketogenic Diet Douses Gout Flares (Cell Rep)

Putting Primary Care on the Gout Care Map (Arthritis Rheumatol)