Gout Linked to Higher Risk of Death Due to Heart Disease

According to a new study men with risk factors for heart disease, have a greater risk of dying from heart problems if they have the arthritic condition gout.

Researchers studied over 9000 middle-aged men at higher-than- average risk of heart disease, and found that those with gout were more likely to die of a heart attack or other cardiovascular causes such as stroke over 17 years.

Lead researcher Dr. Eswar Krishnan, an assistant professor at Stanford University School of Medicine observed that the findings should give men with gout extra incentive to have a doctor assess their cardiac risks.

If they have modifiable risk factors—like high cholesterol, high blood pressure
or obesity, it is highly important to get them under control through diet, exercise, weight loss and medication, said Dr Krishnan.

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

The 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.

Gout is a very painful form of arthritis that causes periodic swelling in the joints. The joints become red and hot and most often the big toe is affected though gout 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.

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Gout.

Gout is a condition characterized by an abnormal metabolism of uric acid. People with gout either produce too much uric acid, or more commonly, their bodies have a problem in removing it. There are a number of possible consequences of this buildup of uric acid in the body, including acute and chronic gouty arthritis, kidney stones, and deposits of uric acid (tophi) in the skin and other tissues. Gout may occur alone (primary gout) or may be associated with other medical conditions or medications (secondary gout).

Gouty arthritis is considered in people who have a sudden onset of a hot, red, swollen joint. It is diagnosed by detecting uric acid (monosodium urate) crystals in the joint fluid. These crystals can accumulate over the years in the joint and trigger repeated bouts of inflammation. Repeated "attacks" of gouty arthritis can damage the joint and lead to chronic arthritis. Fortunately, there are effective medications to treat gout.

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Gout Causes.

Urate

Gout is caused by a build up of uric acid (urate) in your blood. Urate is a normally harmless waste product which is formed when the body breaks down substances known as purines. Two thirds of your urate is produced by your kidneys. The other third is produced by your digestive system. Purines are found naturally in the body, but are also found in some foods and certain types of alcohol.

Urate normally dissolves in your blood, and passes through your kidneys into your urine, ready to be excreted by your body. If you produce too much urate, or excrete too little, the urate builds up and can sometimes cause small sharp crystals to form, usually in a joint, or in the surrounding tissue. It is these crystals that cause the pain, swelling and inflammation associated with gout.

Risk factors

There are some factors which can increase the level of urate in your blood, and therefore also increase your chances of developing gout. These are outlined below.

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• High purine diet - some foods, and certain types of alcohol, are high in purines. Foods such as kidneys, liver, anchovies, herring, and products that contain yeast, can be high in purines. Beer and spirits are also high in purines. Eating lots of purine-rich food and drink can increase your level of urate significantly (see 'prevention' section).Medicines - certain types of medicine can increase your urate level. For example, chemotherapy drugs often affect urate levels.
• Obesity - if you are overweight, losing weight can significantly reduce your urate levels.

There are a number of other medical conditions which can also increase your risk of developing gout. These are detailed below.

• Psoriasis - causes skin cells to reproduce too quickly, leading to red, flaky and crusty skin.
• Hypertension - persistently high blood pressure.
• Diabetes
• Reduced kidney function - for example, after a kidney transplant, or if you have kidney failure
• Hyperlipidaemia - high fat and cholesterol levels in your blood.
• Vascular disease - when your arteries become thickened, narrowed, or blocked.

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Gout Treatment.

There are a number of treatments and medicines that can be used to treat gout. Most treatments for gout aim to reduce the symptoms of pain and swelling. During an attack of gout, it is best to try and rest the affected joint as much as possible. You should also try to keep the joint elevated. Make sure that you drink plenty of fluids, such as water, squash or juice, to ensure that you stay well hydrated. Avoid drinking any alcohol during a gout attack.

Other treatments and medicines that may be used are outlined below.

Medication

Your GP will ensure that any medication you are prescribed is tailored to your individual needs. In order to work out what treatment will be best for you, they will consider your age, general health and any conditions you may already have. If your symptoms of gout are mild, and you experience severe side effects of medication, you may wish to consider treating your condition without the use of prescribed medication. For some people, the downsides of medication can outweigh the benefits. However, this is something you will have to discuss carefully with your GP. You should never stop taking any prescribed medication before speaking to your GP first.

If you are taking any of the medication listed below, you should always return to your GP if your medicine has failed to ease your symptoms after three to four days. It may be that you have to be prescribed a different type of medicine in order for your gout to be treated effectively. You should also see your GP immediately if your symptoms start to worsen after taking medication.

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